THE OFFICIAL PATIENT’S SOURCEBOOK
on
LACTOSE
INTOLERANCE J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Lactose Intolerance: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83397-4 1. Lactose Intolerance-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of lactose intolerance.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to lactose intolerance. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to lactose intolerance, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Appendicitis
·
The Official Patient's Sourcebook on Autoimmune Hepatitis
·
The Official Patient's Sourcebook on Bacteria and Foorborne Illness
·
The Official Patient's Sourcebook on Barrett's Esophagus
·
The Official Patient's Sourcebook on Celiac Disease
·
The Official Patient's Sourcebook on Cirrhosis of the Liver
·
The Official Patient's Sourcebook on Constipation
·
The Official Patient's Sourcebook on Crohn Disease
·
The Official Patient's Sourcebook on Cyclic Vomiting Syndrome
·
The Official Patient's Sourcebook on Diarrhea
·
The Official Patient's Sourcebook on Diverticular Disease
·
The Official Patient's Sourcebook on Fecal Incontinence
·
The Official Patient's Sourcebook on Gallstones
·
The Official Patient's Sourcebook on Gas
·
The Official Patient's Sourcebook on Gastritis
·
The Official Patient's Sourcebook on Gastroparesis
·
The Official Patient's Sourcebook on Hemolytic Uremic Syndrome
·
The Official Patient's Sourcebook on Hemorrhoids
·
The Official Patient's Sourcebook on Hepatitis A
·
The Official Patient's Sourcebook on Hepatitis B
·
The Official Patient's Sourcebook on Hepatitis C
·
The Official Patient's Sourcebook on Hiatal Hernia
·
The Official Patient's Sourcebook on Hirschsprung
·
The Official Patient's Sourcebook on Indigestion
·
The Official Patient's Sourcebook on Inguinal Hernia
·
The Official Patient's Sourcebook on Intestinal Pseudo-obstruction
·
The Official Patient's Sourcebook on Irritable Bowel Syndrome
·
The Official Patient's Sourcebook on Ménétrier
·
The Official Patient's Sourcebook on Pancreatitis
·
The Official Patient's Sourcebook on Peptic Ulcer
·
The Official Patient's Sourcebook on Porphyria
·
The Official Patient's Sourcebook on Primary Biliary Cirrhosis
·
The Official Patient's Sourcebook on Primary Sclerosing Cholangitis
·
The Official Patient's Sourcebook on Proctitis
·
The Official Patient's Sourcebook on Rapid Gastric Emptying
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·
The Official Patient's Sourcebook on Short Bowel Syndrome
·
The Official Patient's Sourcebook on Ulcerative Colitis
·
The Official Patient's Sourcebook on Whipple Disease
·
The Official Patient's Sourcebook on Wilson's Disease
·
The Official Patient's Sourcebook on Zollinger-ellison Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
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Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON LACTOSE INTOLERANCE: GUIDELINES ........................................................................................... 9
Overview............................................................................................................... 9 What Is Lactose Intolerance?.............................................................................. 11 How Is Lactose Intolerance Diagnosed?............................................................. 12 How Is Lactose Intolerance Treated?.................................................................. 13 How Is Nutrition Balanced? .............................................................................. 14 What Is Hidden Lactose?.................................................................................... 17 Summary ............................................................................................................ 18 More Guideline Sources ..................................................................................... 18 Vocabulary Builder............................................................................................. 26
CHAPTER 2. SEEKING GUIDANCE ....................................................... 29
Overview............................................................................................................. 29 Associations and Lactose Intolerance ................................................................. 29 Finding More Associations................................................................................. 31 Finding Doctors.................................................................................................. 33 Selecting Your Doctor ........................................................................................ 34 Working with Your Doctor ................................................................................ 35 Broader Health-Related Resources ..................................................................... 36 Vocabulary Builder............................................................................................. 37
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 39 CHAPTER 3. STUDIES ON LACTOSE INTOLERANCE ............................. 41
Overview............................................................................................................. 41 The Combined Health Information Database ..................................................... 41 Federally-Funded Research on Lactose Intolerance............................................ 50 The National Library of Medicine: PubMed ...................................................... 52 Vocabulary Builder............................................................................................. 53
CHAPTER 4. PATENTS ON LACTOSE INTOLERANCE ........................... 57
Overview............................................................................................................. 57 Patents on Lactose Intolerance ........................................................................... 58 Patent Applications on Lactose Intolerance ....................................................... 58 Keeping Current ................................................................................................. 59
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Contents
CHAPTER 5. BOOKS ON LACTOSE INTOLERANCE ............................... 61
Overview............................................................................................................. 61 Book Summaries: Federal Agencies .................................................................... 61 Book Summaries: Online Booksellers ................................................................. 65 The National Library of Medicine Book Index ................................................... 68 Chapters on Lactose Intolerance ......................................................................... 71 General Home References ................................................................................... 77 Vocabulary Builder............................................................................................. 78
CHAPTER 6. MULTIMEDIA ON LACTOSE INTOLERANCE .................... 81
Overview............................................................................................................. 81 Video Recordings ................................................................................................ 81 Bibliography: Multimedia on Lactose Intolerance.............................................. 83 Vocabulary Builder............................................................................................. 85
CHAPTER 7. PERIODICALS AND NEWS ON LACTOSE INTOLERANCE . 87
Overview............................................................................................................. 87 News Services & Press Releases ......................................................................... 87 Newsletters on Lactose Intolerance .................................................................... 92 Newsletter Articles ............................................................................................. 94 Academic Periodicals covering Lactose Intolerance ........................................... 96 Vocabulary Builder............................................................................................. 97
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ..................... 99
Overview............................................................................................................. 99 NIH Guidelines................................................................................................... 99 NIH Databases.................................................................................................. 100 Other Commercial Databases ........................................................................... 108 The Genome Project and Lactose Intolerance ................................................... 108 Specialized References....................................................................................... 113 Vocabulary Builder........................................................................................... 113
PART III. APPENDICES .................................................. 115 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 117
Overview........................................................................................................... 117 Your Medications: The Basics .......................................................................... 118 Learning More about Your Medications .......................................................... 120 Commercial Databases...................................................................................... 121 Contraindications and Interactions (Hidden Dangers) ................................... 122 A Final Warning .............................................................................................. 123 General References............................................................................................ 123
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 125
Overview........................................................................................................... 125 What Is CAM? ................................................................................................. 125 What Are the Domains of Alternative Medicine?............................................ 126 Can Alternatives Affect My Treatment? ......................................................... 129
Contents
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Finding CAM References on Lactose Intolerance ............................................ 130 Additional Web Resources................................................................................ 137 General References............................................................................................ 142
APPENDIX C. RESEARCHING NUTRITION ......................................... 145
Overview........................................................................................................... 145 Food and Nutrition: General Principles........................................................... 146 Finding Studies on Lactose Intolerance............................................................ 150 Federal Resources on Nutrition........................................................................ 153 Additional Web Resources................................................................................ 154 Vocabulary Builder........................................................................................... 158
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 161
Overview........................................................................................................... 161 Preparation ....................................................................................................... 161 Finding a Local Medical Library ...................................................................... 162 Medical Libraries Open to the Public............................................................... 162
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 169
Overview........................................................................................................... 169 Your Rights as a Patient................................................................................... 169 Patient Responsibilities .................................................................................... 173 Choosing an Insurance Plan............................................................................. 174 Medicare and Medicaid .................................................................................... 176 NORD’s Medication Assistance Programs ..................................................... 179 Additional Resources ........................................................................................ 180
ONLINE GLOSSARIES.................................................... 181 Online Dictionary Directories.......................................................................... 185
LACTOSE INTOLERANCE GLOSSARY ..................... 187 General Dictionaries and Glossaries ................................................................ 196
INDEX................................................................................... 198
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Lactose Intolerance
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Lactose Intolerance has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to lactose intolerance, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on lactose intolerance. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on lactose intolerance should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching lactose intolerance (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to lactose intolerance. It also gives you sources of information that can help you find a doctor in your local area specializing in treating lactose intolerance. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with lactose intolerance. Part II moves on to advanced research dedicated to lactose intolerance. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on lactose intolerance. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with lactose intolerance or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with lactose intolerance. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with lactose intolerance.
Scope While this sourcebook covers lactose intolerance, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that lactose intolerance is often considered a synonym or a condition closely related to the following: ·
Alactasia
·
Dairy Product Intolerance
4
Lactose Intolerance
·
Disaccharidase Deficiency
·
Glucose-galactose Malabsorption
·
Hypolactasia
·
Lactase Deficiency
·
Lactase Isolated Intolerance
·
Milk Intolerance
In addition to synonyms and related conditions, physicians may refer to lactose intolerance using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for lactose intolerance:4 ·
271.3 intestinal malabsorption
·
271.3 intolerance or malabsorption (congenital) of lactose
·
271.3 lactose intolerance
disaccharidase
deficiencies
and
disaccharide
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to lactose intolerance. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with lactose intolerance will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with lactose intolerance is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of lactose intolerance, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on lactose intolerance. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of lactose intolerance to you or even given you a pamphlet or brochure describing lactose intolerance. Now you are searching for more indepth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON LACTOSE INTOLERANCE: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on lactose intolerance. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on lactose intolerance can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on lactose intolerance. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Lactose Intolerance
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with lactose intolerance and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on lactose intolerance.
What Is Lactose Intolerance?7 Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar of milk. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine. Lactase breaks down milk sugar into simpler forms that can then be absorbed into the bloodstream. When there is not enough lactase to digest the amount of lactose consumed, the results, although not usually dangerous, may be very distressing. While not all persons deficient in lactase have symptoms, those who do are considered to be lactose intolerant.
Figure 1. The Digestive Tract
Common symptoms include nausea, cramps, bloating, gas, and diarrhea, which begin about 30 minutes to 2 hours after eating or drinking foods containing lactose. The severity of symptoms varies depending on the amount of lactose each individual can tolerate. Adapted from The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/pubs/lactose/lactose.htm. 7
12 Lactose Intolerance
Some causes of lactose intolerance are well known. For instance, certain digestive diseases and injuries to the small intestine can reduce the amount of enzymes produced. In rare cases, children are born without the ability to produce lactase. For most people, though, lactase deficiency is a condition that develops naturally over time. After about the age of 2 years, the body begins to produce less lactase. However, many people may not experience symptoms until they are much older. Between 30 and 50 million Americans are lactose intolerant. Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African-Americans and Native Americans and 90 percent of Asian-Americans are lactose intolerant. The condition is least common among persons of northern European descent.
How Is Lactose Intolerance Diagnosed? The most common tests used to measure the absorption of lactose in the digestive system are the lactose tolerance test, the hydrogen breath test, and the stool acidity test. These tests are performed on an outpatient basis at a hospital, clinic, or doctor’s office. The lactose tolerance test begins with the individual fasting (not eating) before the test and then drinking a liquid that contains lactose. Several blood samples are taken over a 2-hour period to measure the person’s blood glucose (blood sugar) level, which indicates how well the body is able to digest lactose. Normally, when lactose reaches the digestive system, the lactase enzyme breaks down lactase into glucose and galactose. The liver then changes the galactose into glucose, which enters the bloodstream and raises the person’s blood glucose level. If lactose is incompletely broken down the blood glucose level does not rise, and a diagnosis of lactose intolerance is confirmed. The hydrogen breath test measures the amount of hydrogen in the breath. Normally, very little hydrogen is detectable in the breath. However, undigested lactose in the colon is fermented by bacteria, and various gases, including hydrogen, are produced. The hydrogen is absorbed from the intestines, carried through the bloodstream to the lungs, and exhaled. In the test, the patient drinks a lactose-loaded beverage, and the breath is analyzed at regular intervals. Raised levels of hydrogen in the breath indicate improper digestion of lactose. Certain foods, medications, and cigarettes can
Guidelines 13
affect the test’s accuracy and should be avoided before taking the test. This test is available for children and adults. The lactose tolerance and hydrogen breath tests are not given to infants and very young children who are suspected of having lactose intolerance. A large lactose load may be dangerous for very young individuals because they are more prone to dehydration that can result from diarrhea caused by the lactose. If a baby or young child is experiencing symptoms of lactose intolerance, many pediatricians simply recommend changing from cow’s milk to soy formula and waiting for symptoms to abate. If necessary, a stool acidity test, which measures the amount of acid in the stool, may be given to infants and young children. Undigested lactose fermented by bacteria in the colon creates lactic acid and other short-chain fatty acids that can be detected in a stool sample. In addition, glucose may be present in the sample as a result of unabsorbed lactose in the colon.
How Is Lactose Intolerance Treated? Fortunately, lactose intolerance is relatively easy to treat. No treatment exists to improve the body’s ability to produce lactase, but symptoms can be controlled through diet. Young children with lactase deficiency should not eat any foods containing lactose. Most older children and adults need not avoid lactose completely, but individuals differ in the amounts of lactose they can handle. For example, one person may suffer symptoms after drinking a small glass of milk, while another can drink one glass but not two. Others may be able to manage ice cream and aged cheeses, such as cheddar and Swiss but not other dairy products. Dietary control of lactose intolerance depends on each person’s learning through trial and error how much lactose he or she can handle. For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain lactose, lactase enzymes are available without a prescription. One form is a liquid for use with milk. A few drops are added to a quart of milk, and after 24 hours in the refrigerator, the lactose content is reduced by 70 percent. The process works faster if the milk is heated first, and adding a double amount of lactase liquid produces milk that is 90 percent lactose free. A more recent development is a chewable
14 Lactose Intolerance
lactase enzyme tablet that helps people digest solid foods that contain lactose. Three to six tablets are taken just before a meal or snack. Lactose-reduced milk and other products are available at many supermarkets. The milk contains all of the nutrients found in regular milk and remains fresh for about the same length of time or longer if it is superpasteurized.
How Is Nutrition Balanced? Milk and other dairy products are a major source of nutrients in the American diet. The most important of these nutrients is calcium. Calcium is essential for the growth and repair of bones throughout life. In the middle and later years, a shortage of calcium may lead to thin, fragile bones that break easily (a condition called osteoporosis). A concern, then, for both children and adults with lactose intolerance, is getting enough calcium in a diet that includes little or no milk. In 1997, the Institute of Medicine released a report recommending new requirements for daily calcium intake. How much calcium a person needs to maintain good health varies by age group. Recommendations from the report are as follows: Age group (mg) 0-6 months 6-12 months 1-3 years 4-8 years 9-18 years 19-50 years 51-70 years
Amount of calcium to consume daily in milligrams 210 mg 270 mg 500 mg 800 mg 1,300 mg 1,000 mg 1,200 mg
Also, pregnant and nursing women under 19 need 1,300 mg daily, while pregnant and nursing women over 19 need 1,000 mg. In planning meals, making sure that each day’s diet includes enough calcium is important, even if the diet does not contain dairy products. Many nondairy foods are high in calcium. Green vegetables, such as broccoli and kale, and fish with soft, edible bones, such as salmon and sardines, are
Guidelines 15
excellent sources of calcium. To help in planning a high-calcium and lowlactose diet, figure 2 lists some common foods that are good sources of dietary calcium and shows about how much lactose the foods contain. Recent research shows that yogurt with active cultures may be a good source of calcium for many people with lactose intolerance, even though it is fairly high in lactose. Evidence shows that the bacterial cultures used in making yogurt produce some of the lactase enzyme required for proper digestion.
16 Lactose Intolerance
Clearly, many foods can provide the calcium and other nutrients the body needs, even when intake of milk and dairy products is limited. However, factors other than calcium and lactose content should be kept in mind when
Guidelines 17
planning a diet. Although some vegetables are high in calcium (Swiss chard, spinach, and rhubarb, for instance), the body cannot use their calcium content. They contain substances called oxalates, which stop calcium absorption. Calcium is absorbed and used only when there is enough vitamin D in the body. A balanced diet should provide an adequate supply of vitamin D. Sources of vitamin D include eggs and liver. However, sunlight helps the body naturally absorb or synthesize vitamin D, and with enough exposure to the sun, food sources may not be necessary. Some people with lactose intolerance may think they are not getting enough calcium and vitamin D in their diet. Consultation with a doctor or dietitian may be helpful in deciding whether any dietary supplements are needed. Taking vitamins or minerals of the wrong kind or in the wrong amounts can be harmful. A dietitian can help in planning meals that will provide the most nutrients with the least chance of causing discomfort.
What Is Hidden Lactose? Although milk and foods made from milk are the only natural sources, lactose is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain lactose, even in small amounts. Food products that may contain lactose include: ·
Bread and other baked goods
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Processed breakfast cereals.
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Instant potatoes, soups, and breakfast drinks.
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Margarine.
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Lunch meats (other than kosher)
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Salad dressings.
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Candies and other snacks
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Mixes for pancakes, biscuits, and cookies.
Some products labeled nondairy, such as powdered coffee creamer and whipped toppings, may also include ingredients that are derived from milk and therefore contain lactose. Smart shoppers learn to read food labels with care, looking not only for milk and lactose among the contents but also for such words as whey, curds, milk
18 Lactose Intolerance
by-products, dry milk solids, and nonfat dry milk powder. If any of these are listed on a label, the item contains lactose. In addition, lactose is used as the base for more than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines. Many types of birth control pills, for example, contain lactose, as do some tablets for stomach acid and gas. However, these products typically affect only people with severe lactose intolerance.
Summary Even though lactose intolerance is widespread, it need not pose a serious threat to good health. People who have trouble digesting lactose can learn which dairy products and other foods they can eat without discomfort and which ones they should avoid. Many will be able to enjoy milk, ice cream, and other such products if they take them in small amounts or eat other food at the same time. Others can use lactase liquid or tablets to help digest the lactose. Even older women at risk for osteoporosis and growing children who must avoid milk and foods made with milk can meet most of their special dietary needs by eating greens, fish, and other calcium-rich foods that are free of lactose. A carefully chosen diet (with calcium supplements if the doctor or dietitian recommends them) is the key to reducing symptoms and protecting future health.
More Guideline Sources The guideline above on lactose intolerance is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to lactose intolerance. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with lactose intolerance. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Guidelines 19
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on lactose intolerance and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Healthy Eating Makes A Difference: A Food Resource... for People Living With HIV Contact: Canadian Hemophilia Society, Education Program, 1255 Rue University, Bur 702, Montreal, (514) 875-8375. Summary: This teaching aid presents information on healthy eating and nutrition for HIV-positive individuals. It discusses food and the immune system, gives a guide to healthy food choices, examines the relationship between maintaining weight and exercise, and cautions the reader about safely preparing food. Individual problems that may be encountered,
20 Lactose Intolerance
such as lactose intolerance, diarrhea, loss of appetite, and wasting, are explained. The resource guide includes menu plans and recipes. ·
Senior Sense for Healthy Eating Source: Seattle, WA, the Council, 6 pieces in a folder, 1985. Contact: Washington State Dairy Council, 3830 Stone Way North, Seattle, WA 98103. Summary: Senior Sense for Healthy Eating is a resource packet developed by the Washington State Dairy Council as an aid for health professionals preparing presentations on the subject of nutrition for normal, healthy, aging persons. The resource packet provides scientifically sound, current information on this topic, as well as suggestions for activities, sample handouts, and a list of selected references. Two major nutritional concerns with this population are undernutrition or starvation and overnutrition or obesity. Topics discussed include (1) the influence of physiological, psychological, social, and economic factors on nutritional status; (2) nutritional needs of elderly persons; (3) making eating more enjoyable; (4) low-cost nutrition; and (5) special concerns such as prescription drugs, lactose intolerance, and food faddism. 13 references.
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Lactose Intolerance: A Problem with Dairy Foods Source: San Bruno, CA: StayWell Company. 1998. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $ 17.95 for 50 copies; plus shipping and handling; bulk copies available. Order number 9782. Summary: This brochure describes lactose intolerance, a condition in which the person cannot digest lactose, a sugar found in milk and other dairy products. Undigested lactose is not harmful, but it can cause unpleasant symptoms. People who are lactose intolerant may notice the following symptoms about an hour or more after eating and drinking dairy products: gas or bloating, abdominal cramps and pain, rumbling stomach, and diarrhea. Diagnostic tests used to confirm lactose intolerance include a lactose intolerance test, breath test, stool test, or blood test. The brochure outlines strategies for people wishing to reduce symptoms, including choosing low lactose dairy products, eating foods with active cultures (such as yogurt), eating or drinking dairy products in conjunction with other foods, substituting fruit juice for milk in recipes, taking lactase enzyme tablets when ingesting dairy products, and avoiding eating many high lactose foods (such as milk, cream, butter, and
Guidelines 21
ice cream) at one time. The brochure also offers a chart of nondairy substitutes for common dairy products. One section reminds readers that if they are cutting down on dairy products, then they must replace the calcium in their diet with other foods. A list of high calcium, dairy free foods is provided. A final section encourages readers to consult nutrition labels to determine the presence of lactose in a food product. The brochure is illustrated with full color drawings. 6 figures. ·
Irritable Bowel Syndrome: Tips on Controlling Your Symptoms Source: Kansas City, MO: American Academy of Family Physicians. 1993. 4 p. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Price: $22.00 for 100 copies for members, $33.00 for 100 copies for nonmembers. Summary: This patient education brochure helps readers understand irritable bowel syndrome (IBS) and how they can control the symptoms it may cause. In IBS, the intestines squeeze too hard or not hard enough and cause food to move too fast or too slowly through the gastrointestinal (GI) tract. IBS can cause diarrhea, constipation, or both. The symptoms may get worse when the patient experiences stress, including that associated with travel, social events, menstrual cycles, or a change in daily routine. The brochure outlines diagnostic and treatment options, the role of dietary fiber, the impact of diet on IBS symptoms, the role of milk and milk products and the issue of lactose intolerance, managing stress, and drug therapy. The brochure notes that because IBS is a chronic disease, health care providers are hesitant to prescribe long term drug therapy. However, for acute attacks, antispasmodic drugs, loperamide, sedatives, or antidepressants may be prescribed. The brochure encourages readers to find new freedom from IBS by following a management plan that includes a healthy diet, learning new ways to deal with stress, and avoiding foods that make symptoms worse. 2 tables. (AA-M).
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Dietary Suggestions for Managing Diarrhea Source: Rochester, MN: Mayo Clinic, Patient and Health Education Center. 1990. 2 p. Contact: Available from Mayo Clinic, Patient and Health Education Center. 200 First Street , SW, Rochester, MN 55905. (507) 284-2511. Price: $0.80 plus shipping and handling (for health care professionals). Order Number MC590/R290.
22 Lactose Intolerance
Summary: Diarrhea may be caused by some drugs, chemotherapy, radiation therapy, stress, intestinal surgery, or sensitivity to certain foods. This patient education brochure offers dietary suggestions for managing diarrhea. Topics include limiting foods that contain fiber; increasing the use of low-fiber foods; managing lactose intolerance; meal planning and scheduling; the importance of adequate fluid intake; and the use of a clear liquid diet to rest the bowel. The brochure includes blank spaces for the listing of health care providers and phone numbers. ·
Lactose Intolerance. [Intolerancia Lactosa] Source: Camp Hill, PA: Chek-Med Systems, Inc. 199x. 2 p. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797. Fax (717) 761-0216. Price: $22 per packet of 50 pamphlets for order of 3 to 10 packets; minimum order 3 packets. Discounts available for larger quantities and complete kits of gastroenterology pamphlets. Summary: This patient education brochure, available in English and Spanish, provides basic information about lactose intolerance. Topics covered include a description of lactase and its role in digesting lactose; the occurrence of lactose intolerance; symptoms; diagnostic tests, including a lactose tolerance test, the hydrogen breath test, and a stool acidity test; and treatment options. The brochure concludes with a reminder to readers of the need for adequate amounts of calcium and includes a chart of the calcium and lactose content of several common foods. The brochure includes a blank space for the physician to provide individualized patient instructions. Simple line drawings illustrate some concepts. 2 figures. 1 table.
·
Lactose Intolerance Source: Bethesda, MD: American Gastroenterological Association. 199x. [4 p.]. Contact: American Gastroenterological Association (AGA). 7910 Woodmont Avenue, Seventh Floor, Bethesda, MD 20814. (800) 668-5237 or (301) 654-2055. Fax (301) 652-3890. Website: www.gastro.org. Price: Single copy free; bulk copies available. Summary: Lactose intolerance is the inability to digest significant amounts of lactose, which is the predominant sugar of milk. This brochure from the American Gastroenterological Association (AGA) reviews the problem of lactose intolerance. People who have trouble digesting lactose can learn, by testing themselves, which dairy products and other foods they can eat without discomfort and which ones they
Guidelines 23
should avoid. Topics include a description of lactose intolerance and its causes, diagnostic tests used to confirm the condition, and treatment options. Common symptoms of lactose intolerance include nausea, cramps, bloating, gas, and diarrhea, which begin 30 minutes to two hours after eating or drinking foods containing lactose. The severity of symptoms varies depending on the amount of lactose each individual can tolerate. The most common tests used to measure the absorption of lactose in the digestive system are the lactose intolerance test, the hydrogen breath test, and the stool acidity test. Many people with lactose intolerance can enjoy milk, ice cream, and other such products if they take them in small amounts or eat other kinds of food at the same time. Others can use lactase liquid or tablets to help digest the lactose. Even older women and children who must avoid milk and foods made with milk can meet most of their special dietary needs by eating greens, fish, and other calcium rich foods that are free of lactose. A carefully chosen diet (with calcium supplements if the doctor recommends them) is the key to reducing symptoms and protecting future health. The brochure includes a diagram of the digestive tract, with organs labeled. 1 figure. 4 references. ·
Lactose intolerance. (Rev. ed.) Source: Chicago, IL: American Dietetic Association. 1991. 21 pp. Contact: Available from Customer Service, American Dietetic Association, 216 West Jackson Boulevard, Suite 800, Chicago, IL 606066995. Telephone: (312) 899-0040 or (800) 877-1600 or (800) 366-1655 or (800) 225-5267 / fax: (312) 899-1758 / Web site: http://www.eatright.org. $5.50 ADA members; $6.50 nonmembers; prepayment required; make checks payable to ADA. Summary: This booklet provides suggestions for people with lactose intolerance; it is intended to help them control their condition. It discusses the causes and symptoms of the condition, provides tips to help them tolerate the use of milk, and indicates terms they should know as they read food labels. The booklet also covers the lactose content of common foods, special nutritional concerns, alternative sources of calcium, and meal planning; it lists resources and includes some lactosefree recipes.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other
24 Lactose Intolerance
countries. You can search their site located at http://www.guideline.gov by using the keyword “lactose intolerance” or synonyms. The following was recently posted: ·
AACE medical guidelines for clinical practice for management of menopause. Source: American Association of Clinical Endocrinologists.; 1999 NovDecember; 13 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1364&sSearch_string=lactose+intolerance
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Diagnosis and management of foodborne illnesses: a primer for physicians. Source: American Medical Association/Center for Food Safety and Applied Nutrition/Centers for Disease Control and Prevention/Food Safety and Inspection Service.; Reprint released 2001 January; 88 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1933&sSearch_string=lactose+intolerance
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Evidence based clinical practice guideline for children with acute gastroenteritis (AGE) in children aged 2 months to 5 years. Source: Cincinnati Children's Hospital Medical Center.; 1999 November (revised 2001 Apr); 13 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2343&sSearch_string=lactose+intolerance
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Manual for radiation oncology nursing practice and education. Source: Oncology Nursing Society.; 1998; 79 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0913&sSearch_string=lactose+intolerance
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:
Guidelines 25
·
Lactose Intolerance Summary: Frequently asked questions about lactose intolerance, the inability to digest significant amounts of lactose, the predominant sugar of milk. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6299 The NIH Search Utility
After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to lactose intolerance. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
26 Lactose Intolerance
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Acidity: L. aciditas) the quality of being acid or sour; containing acid (hydrogen ions). [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chronic: Persisting over a long period of time. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and
Guidelines 27
weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hydrogen: Hydrogen. The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Oxalates: Salts and esters of oxalic acid. [NIH] Sedative: 1. allaying activity and excitement. 2. an agent that allays excitement. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU]
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Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH]
Seeking Guidance 29
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with lactose intolerance. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with lactose intolerance. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Lactose Intolerance As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
30 Lactose Intolerance
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Celiac Society-Dietary Support Coalition Address: American Celiac Society-Dietary Support Coalition 59 Crystal Avenue, West Orange, NJ 07052 Telephone: (973) 325- 8837 Toll-free: (888) 663-4637 Fax: (973) 669-8808 Email:
[email protected] Background: The American Celiac Society-Dietary Support Coalition is a nonprofit self-help organization that provides support, education, and encouragement for people with Celiac Sprue and other dietary disorders and food allergies, including Dermatitis Herpetiformis, Crohn's Disease, Lactose Intolerance, and Wheat Intolerance. Through patient and general education, nationwide support groups, networking, referrals, and research, ACS/DCS works to increase the awareness of dietary disorders and to identify food products that may contain gluten-gliaden, lactose, corn or soya. ACS/DCS also publishes a newsletter, patient packets, brochures, and offers audio-visual aids for its members. The society offers some Spanish language materials, and has limited Spanish and Italian speaking resources.
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Intestinal Disease Foundation Address: Intestinal Disease Foundation 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219 Telephone: (412) 261-5888 Toll-free: (888) 663-4637 Fax: (412) 471-272 Background: The Intestinal Disease Foundation (IDF) is an international not- for-profit organization dedicated to providing information, assistance, and mutual support to individuals with chronic intestinal illnesses including irritable bowel syndrome, diverticular disease, ulcerative colitis, Crohn's disease, and short-bowel syndrome.
Seeking Guidance 31
Established in 1986 and consisting of 1,400 members in the United States and abroad, IDF promotes healing by encouraging individuals to assume an active role in their own treatment through a positive mental attitude founded on shared experiences. This is facilitated by a telephone network of individuals with intestinal illnesses who provide support, encouragement, and information. The Foundation publishes a quarterly newsletter entitled 'Intestinal Fortitude' as well as a variety of informational brochures and educational materials on chronic intestinal diseases and conditions. Relevant area(s) of interest: Diarrhea, Diverticular Disease, Irritable Bowel Syndrome, Lactose Intolerance, Proctitis, Short Bowel Syndrome ·
March of Dimes Birth Defects Foundation Address: March of Dimes Birth Defects Foundation 1275 Mamaroneck Avenue, White Plains, NY 10605 Telephone: (914) 428-7100 Toll-free: (888) 663-4637 Fax: (914) 997-4763 Email:
[email protected] Web Site: http://www.modimes.or Background: The March of Dimes Birth Defects Foundation is a national not-for- profit organization that was established in 1938. The mission of the Foundation is to improve the health of babies by preventing birth defects and infant mortality. Through the Campaign for Healthier Babies, the March of Dimes funds programs of research, community services, education, and advocacy. Educational programs that seek to prevent birth defects are important to the Foundation and to that end it produces a wide variety of printed informational materials and videos. The March of Dimes public health educational materials provide information encouraging health- enhancing behaviors that lead to a healthy pregnancy and a healthy baby. Relevant area(s) of interest: Lactose Intolerance, Porphyria, Wilson's Disease
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
32 Lactose Intolerance
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about lactose intolerance. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “lactose intolerance” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “lactose intolerance”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “lactose intolerance” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with lactose intolerance. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option
Seeking Guidance 33
called “Organizational Database (ODB)” and type “lactose intolerance” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with lactose intolerance must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
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Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
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Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
10
Check with the associations listed earlier in this chapter.
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
34 Lactose Intolerance
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about lactose intolerance?
·
Really listen to my questions?
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 12 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 11
Seeking Guidance 35
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for lactose intolerance?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
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Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
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Tell your doctor about any natural or alternative medicines you are taking.
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Bring other medical information, such as x-ray films, test results, and medical records.
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Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
13
36 Lactose Intolerance
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
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Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
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Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
Seeking Guidance 37
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Proctitis: Inflammation of the rectum. [EU]
39
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on lactose intolerance. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on lactose intolerance. In Part II, as in Part I, our objective is not to interpret the latest advances on lactose intolerance or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with lactose intolerance is suggested.
Studies 41
CHAPTER 3. STUDIES ON LACTOSE INTOLERANCE Overview Every year, academic studies are published on lactose intolerance or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on lactose intolerance. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on lactose intolerance and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and lactose intolerance, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
42 Lactose Intolerance
format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “lactose intolerance” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Influence of the Pharmacological Modification of Gastric Emptying on Lactose Digestion and Gastrointestinal Symptoms Source: Alimentary Pharmacology and Therapeutics. 13(1): 81-86. January 1999. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: In people who have difficulty digesting lactose (milk sugar), the ingestion of food that retards gastric emptying improves tolerance to lactose. This article reports on a randomized, double blind study undertaken to investigate the effects of the pharmacological modification of gastric emptying on the speed of development of lactose induced symptoms. After an overnight fast, 18 people who had trouble digesting lactose were given, at 1 week intervals, either propantheline, metoclopramide, or placebo (in identical capsules), 60 minutes before ingesting 50 g lactose colored with 1 g carmine dye (to measure gastrointestinal time). Gastrointestinal symptoms, urinary galactose excretion, and breath hydrogen and blood glucose concentrations were recorded. The propantheline induced prolongation of gastric emptying improved tolerance to lactose, compared with placebo or metoclopramide. The total hydrogen excretion increased by 15 percent after metoclopramide (as compared with placebo). Propantheline decreased this variable by 15 percent from placebo. Non-significant differences in blood glucose, urinary galactose, or gastrointestinal transit time were found. The authors conclude that delaying gastric emptying improves lactose intolerance in individuals who have trouble digesting lactose. 1 figure. 1 table. 16 references. (AA-M).
·
Recognizing and Alleviating the Symptoms of Lactose Intolerance Source: Digestive Health and Nutrition. p. 16-20. November-December 1999.
Studies 43
Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. E-mail:
[email protected]. Summary: This article reviews the symptoms of lactose intolerance and offers strategies for alleviating those symptoms. The author notes that many adults lose their ability to digest milk after childhood. The culprit, a sugar called lactose that is found in dairy products, cannot be absorbed by the body unless it is broken down by an enzyme called lactase in the digestive system. Most people produce less lactase as they age, and this can result in a very uncomfortable, but rarely dangerous, disorder called lactose intolerance. Without the help of a physician, lactose intolerance can be a tricky disorder to diagnose for a number of reasons: the symptoms are similar to many other food intolerance problems, and the different tolerance levels in different people. Lactose can be present in many different foods and even in medications (20 percent of prescription drugs and about 6 percent of over the counter medications contain lactose). The article outlines the diagnostic tests used to confirm lactose intolerance and then offers suggestions for readers who definitely are lactose intolerant. The author cautions that eliminating all dairy products can cause other problems, including a shortage of calcium and other nutrients. For most people with lactose intolerance, eliminating some, but not necessarily all, dairy products is an options. Research studies have shown that people with confirmed low levels of lactase can still consume one serving of milk with a meal or as many as two servings per day when divided between breakfast and dinner, without experiencing symptoms. In addition, some dairy products have less lactose than others. Over the counter drops and tablets containing lactase also are available to assist with the digestion of dairy products without discomfort. The article concludes with the web sites of organizations from which readers can get additional information. 3 tables. 3 references. ·
Irritable Bowel Syndrome: Causes and Treatment Source: Gastroenterology Nursing. 23(6): 256-263. November-December 2000. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555. Summary: Irritable bowel syndrome (IBS) is a common health care problem worldwide. In the United States and Northern European countries, more women than men seek health care services for IBS. Nurses are often called on to help women with IBS managed their symptoms. This article reviews the literature related to gender differences in diagnosis, symptoms (gastrointestinal, somatic, and disturbed sleep),
44 Lactose Intolerance
and physiological and psychological factors as well as current drug therapies used in the management of IBS. At this time, IBS is a diagnosis of exclusion. The classic symptoms associated with IBS include abdominal pain and changes in bowel patterns. Symptoms of IBS, including alterations in stool patterns, abdominal discomfort, and bloating, often mimic dietary intolerances, including lactose intolerance and dietary insufficiencies such as low fiber intake. IBS may be a three component disorder characterized by dysfunctions in visceral motor activity, visceral sensation (an increase in bowel sensitivity with bowel distention), and the central nervous system. Traditional therapies of IBS include psychological intervention, diet counseling, and pharmacologic agents such as antidiarrheals, antispasmodics, antidepressants, and laxatives. Nurses who are involved in the care of patients with IBS are often called on to provide education, reassurance, and guidance as well as new information related to the pathophysiology and management of IBS. The authors briefly note that many patients use other lifestyle changes, diet therapy, and alternative therapies (including acupuncture) to help manage their IBS. 3 tables. 59 references. ·
Widening Spectrum of Celiac Disease Source: American Journal of Clinical Nutrition. 69(3): 354-365. March 1999. Contact: Available from American Journal of Clinical Nutrition. Production Office, 9650 Rockville Pike, Bethesda, MD 20814. (301) 5307038. Fax (301) 571-8303. Website: www.ajcn.org. Summary: Celiac disease is a permanent intolerance to ingested gluten that results in immunologically mediated inflammatory damage to the small intestinal mucosa. This article considers the widening spectrum of celiac disease. Celiac disease is associated with both human leukocyte antigen (HLA) and non HLA genes and with other immune disorders, notably juvenile diabetes and thyroid disease. The classic sprue syndrome of steatorrhea (fat in the feces) and malnutrition coupled with multiple deficiency states may be less common than more subtle and often monosymptomatic presentations of the disease. Diverse problems such as dental anomalies, short stature, osteopenic bone disease, lactose intolerance, infertility, and nonspecific abdominal pain among many others may be the only manifestations of celiac disease. The rate at which celiac disease is diagnosed depends on the level of suspicion for the disease. Although diagnosis relies on intestinal biopsy findings, serologic tests are useful as screening tools and as an adjunct to diagnosis. The treatment of celiac disease is lifelong avoidance of dietary gluten. Gluten free diets are now readily achievable with appropriate professional
Studies 45
instruction and community support. Both benign and malignant complications of celiac disease occur but these can often be avoided by early diagnosis and compliance with a gluten-free diet. 5 figures. 4 tables. 121 references. ·
Gastrointestinal Disorders: Roles of Nutrition and the Dietetics Practitioner Source: Journal of the American Dietetic Association. 98(3): 272-277. March 1998. Summary: This article outlines the roles of nutrition and dietetics practitioners in the overall management of patients with gastrointestinal (GI) problems. The author stresses that because of their training and experiences in the areas of food, nutrition, and management, dietetics practitioners have the opportunity to make an important contribution to the care of patients with GI disorders. The author discusses the development of screening and assessment programs; the evaluation of nutritional status in GI disorders; the development of protocols, standards of care, and critical pathways; quality improvement and assessment; the role of research; roles in working with both ambulatory and inpatient clients; putting lactose intolerance into perspective; indigestion associated with ingestion of spicy foods; the role of dietetics practitioners in the care of patients with inflammatory bowel disease (IBD) or those with short-bowel syndrome; and the evaluation of enteral formulas for nutrition support. The author notes that most people are relieved to learn that common GI problems are relatively innocuous and are easily explained by well-established food physiology mechanisms. However, many people cling to myths and their own beliefs about foods and their body's reactions to them. It is the role of the dietetics professional to guide clients to a more rational, science-based understanding of food physiology mechanisms. The author concludes that application of the more artistic side of dietetics, involving human relations, counseling, and management, can be equally valuable when replacing practices based on conjecture and old paradigms with sound standards of care. 2 tables. 48 references.
·
Allaying Fears and Fallacies About Lactose Intolerance Source: Journal of the American Dietetic Association. 98(6): 671-676. June 1998. Summary: This review article is intended to help dietetic professionals alleviate clients fears about lactose intolerance and recommend dietary strategies to improve tolerance. Public awareness and misunderstanding of lactose intolerance are at an all-time high. Many people erroneously
46 Lactose Intolerance
believe that they develop gastrointestinal symptoms after ingesting lactose. Consequently, lactose-containing foods such as milk and other dairy products may be eliminated unnecessarily from the diet. Because these foods are a major source of calcium, low intake can compromise calcium nutrition. This, in turn, can increase the risk of major chronic diseases such as osteoporosis (porous bones) and hypertension. Scientific study indicates that the prevalence of lactose intolerance is grossly overestimated. Other physiologic and psychologic factors can contribute to gastrointestinal symptoms that mimic lactose intolerance. Scientific findings also indicate that people with laboratory-confirmed low levels of lactase can consume one serving of milk with a meal or two servings of milk per day in divided doses at breakfast and dinner without experiencing symptoms. Several dietary strategies are available to help lactose maldigesters include milk and other dairy foods in their diet without experiencing symptoms. These include the use of lactosereduced or lactose-free dairy foods, lactose digestive aids, and a gradual increase in intake of dairy foods. 2 tables. 57 references. (AA). ·
When to Suspect Lactose Intolerance: Symptomatic, Ethnic, and Laboratory Clues Source: Postgraduate Medicine. 104(3): 109-111, 115-116, 122-123. September 1998. Summary: Lactose intolerance is the inability to digest significant amounts of lactose (the sugar found in milk and dairy products). Lactose intolerance affects millions of people worldwide and should be suspected particularly when evaluating gastrointestinal symptoms in ethnic populations in which it is prevalent. The authors of this article discuss symptoms and methods of detection and offer their recommendations for helping patients with this common disorder. Daily ingestion of less than 240 mL of milk is well tolerated by most adults with lactose intolerance. Some persons with normal lactase activity may become symptomatic after consuming products containing lactose. Lactose maldigestion can coexist in adults with irritable bowel syndrome (IBS) and in children with recurrent abdominal pain. Management consists primarily of dietary changes. People who avoid dairy products should receive calcium supplementation and should be advised to read ingredient labels carefully. Several lactase replacement products are available, but their efficacy varies. One sidebar discusses hidden sources of lactose, listing common foods that may contain lactose. 4 tables. 21 references. (AA-M).
·
Commonsense Approach to Lactose Intolerance Source: Patient Care. 31(7): 185-190, 195. April 15, 1997.
Studies 47
Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: Many adults avoid milk and milk products because they believe that even small quantities of lactose will cause diarrhea, bloating, and flatulence resulting from lactose intolerance. However, the author of this article stresses that nearly everyone can tolerate moderate amounts of lactose. A sizable fraction of people self-diagnosed as having lactose intolerance actually absorb lactose completely, and virtually all lactose malabsorbers tolerate moderate amounts of lactose without exhibiting discernible symptoms. The author describes the importance of milk in the adult diet, notably to counter the bone loss usually observed in middle and late adulthood. An additional section describes lactose digestion and lactase activity. One sidebar explores the physiology of lactose digestion in detail. Lactose digestive aids are available in several formulations at varying cost; these include lactase-containing drops and tablets that resist acid-peptic denaturation in the stomach. The author concludes by describing how the symptomatic and breath-hydrogen response of people with lactase nonpersistence appears to decrease when they regularly consume large amounts of lactose. This improved tolerance apparently reflects an adaptation by the colonic flora, resulting in increased metabolism of lactose via non-gas-forming reactions. 1 figure. 2 tables. 5 references. ·
Modern Management of Acute Diarrhea and Dehydration in Children Source: American Family Physician. 51(5): 1103-1115. April 1995. Summary: In this article, the author reviews the modern management of acute diarrhea and dehydration in children. The major advance in this area has been the development of oral rehydration therapy, which is effective for the treatment of diarrhea of any etiology in patients of any age. The author discusses optimal management of acute infectious diarrhea, including rapid rehydration (and maintenance of hydration) using an appropriate glucose based or cereal-based oral rehydration solution (ORS); early refeeding with a mixed diet and no interruption of breast feeding; continuation of lactose containing foods unless clinical signs of lactose intolerance develop; and a staged laboratory evaluation, with the administration of antimicrobial therapy when indicated. 3 figures. 7 tables. 51 references. (AA-M).
·
Lactose Intolerance: The Full Story Source: Ostomy Quarterly. 32(2): 24-26. Spring 1995.
48 Lactose Intolerance
Contact: Available from United Ostomy Association, Inc. 36 Executive Park, Suite 120, Irvine, CA 92714-6744. (800) 826-0826 or (714) 660-8624. Summary: This newsletter article familiarizes readers with lactose intolerance. Topics include causes; diagnostic tests; foods that contain lactose; medications that contain lactose; and treatment options. The article concludes with a list of resources through which readers can obtain additional information. 1 table. ·
Lactose Intolerance (editorial) Source: New England Journal of Medicine. 333(1): 53-54. July 6, 1995. Summary: In this letter to the New England Journal of Medicine, the author comments on a research report on lactose intolerance published in the same issue. The author of this editorial focuses on the difference between people who attribute abdominal symptoms to lactose intolerance and those who ignore the same symptoms. The research study found that, when lactose intake is limited to the equivalent of 240ml of milk or less per day, symptoms are likely to be negligible and the use of lactose-digestive aids unnecessary. The author of this editorial contends that the interplay of mind and body is critical in the development of abdominal symptoms. 14 references. (AA-M).
·
Got Lactose Intolerance? Source: Digestive Health and Nutrition. 4(1):20. January-February 2002. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. E-mail:
[email protected]. Summary: This brief newsletter article familiarizes readers with lactose (milk sugar) intolerance and how to determine the level of one's own lactose intolerance. The author reports on a recent study in which a group of self-diagnosed individuals were tested for lactose intolerance and 31 percent comfortably digested two cups of milk. For those with severe lactose intolerance, total avoidance of milk products may be necessary. However, there are degrees to lactase deficiency. Lactase is the enzyme in the human digestive system that breaks down lactose. Symptoms of lactose intolerance occur only when the individual takes in more lactose than can be broken down by the lactase in their system. The author stresses than an unnecessary restriction to one's diet is not appropriate unless a physician has diagnosed lactose intolerance. When trying to determine the body's level of tolerance, the best method is trial and error. Once a person knows his or her level of tolerance, they can work toward improving their tolerance for dairy foods by consistently
Studies 49
including them in the diet, spread throughout the day so as not to overwhelm the body. The article concludes with the websites of three organizations through which readers can get additional information. 3 references. ·
Lactose Intolerance: Problems in Diagnosis and Treatment Source: Journal of Clinical Gastroenterology. 28(3): 208-216. April 1999. Contact: Available from Lippincott-Raven Publishers. P.O. Box 1550, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Summary: Lactose (milk sugar) malabsorption and lactase deficiency are chronic organic pathologic conditions characterized by abdominal pain and distention, flatulence (gas), and the passage of loose, watery stools. This article reviews problems in the diagnosis and treatment of lactose intolerance. Though malabsorption of sugar lactose can be determined by breath hydrogen test or jejunal biopsy, intolerance can be confirmed only by challenge with food containing lactose, and the response to it may not be immediate. The difficulty of making a positive diagnosis of these conditions has led to a proportion of lactose intolerant patients being misdiagnosed with irritable bowel syndrome (IBS), which has a remarkably similar symptom complex and for which there is no current pathophysiologic marker. The incidence of the two disorders is approximately equal, but the actual proportion of patients with IBS incorrectly diagnosed in this way varies as a function of the methodology used. Once the correct diagnosis is established, introduction of a lactose free dietary regime relieves symptoms in most patients. Symptom similarity and the resultant incorrect diagnosis of IBS may explain the refractory nature of some patients who are thought to have IBS and remain largely unaware of the relationship between food intake and symptoms. 4 tables. 80 references. (AA).
·
Weight-Gain Arrest Secondary to Lactose Intolerance Source: JAAPA. Journal of the American Academy of Physician Assistants. 11(1): 19-20, 25. January 1998. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: There are many reasons that an infant may fail to grow, but food intolerance is often the culprit. This article explores problems of lactose intolerance in infants. Lactose intolerance is particularly significant in infants because milk is the major component of their diet. Severe symptoms of diarrhea, intestinal gas, and nausea can result in malnutrition and lack of weight gain. The authors help readers
50 Lactose Intolerance
understand the mechanisms of lactose intolerance in order to better manage patients with this problem. The article begins with a case presentation of a 17 month old girl with a 10 month history of arrested weight gain. The authors use this case to demonstrate how the growth curves can be used to diagnose problems. Lactose intolerance results when the body cannot produce lactase, the enzyme that hydrolyzes lactose to glucose and galactose. When this enzyme is absent or deficient, lactose accumulates in the gut. Subsequent fermentation in the gut produces gas and acidic contents. Familial investigations have established that the persistence of lactose absorption is inherited as an autosomal dominant characteristic. Secondary disaccharidase deficiency (SDD) is not hereditary. This disorder of the small intestine involves diffuse mucosal injury caused by several mechanisms and results in diminished activity of all the disaccharidases. The authors briefly review the diagnostic tests used to determine lactose intolerance. They also note that lactose tolerance can be spontaneously restored if the patient has no latent genetic predisposition to hereditary lactase deficiency (HLD) and if damage to the mucosa heals. 2 figures. 12 references.
Federally-Funded Research on Lactose Intolerance The U.S. Government supports a variety of research studies relating to lactose intolerance and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.15 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to lactose intolerance and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore lactose intolerance and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could 15 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
Studies 51
eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for lactose intolerance: ·
Project Title: Consumption
Symptoms
of
Lactose
Intolerance
After
Milk
Principal Investigator & Institution: Bahar, Ronald; University of California Los Angeles Box 951361, 405 Hilgard Ave Los Angeles, Ca 90095 Timing: Fiscal Year 2000 Summary: The aims are to determine what parentage of adolescents who claim to have lactose intolerance are incorrectly self-diagnosed, and to promote adequate cow's milk consumption in adolescents. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Building Better Bones in Children Principal Investigator & Institution: Zemel, Babette S.; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2000; Project Start 1-JUN-1999; Project End 1-MAY2004 Summary: Increased calcium intake has proven effective in increasing bone mineral density in children, but the effect disappears when calcium supplements are discontinued. Increased dietary calcium from daily and other food sources may have an even greater impact on bone density than that achieved by calcium supplements, but achieving sustained increased calcium from food sources has not been demonstrated. In addition, the effects of baseline characteristics of calcium intake and bone density and puberty status may influence the response to intervention. This study will develop and implement a Behavioral ModificationNutrition Education (BM-NE) Intervention Program aimed at increasing dietary calcium Male and female subjects (n=154), ages 7-10 years (Tanner stage I or II), will be randomly assigned to participate in an intensive BM-NE intervention group to increase intake to 1500 mg/d or a group that will receive usual care (UC) as counseling on bone health. The BM-NE Program will consist of five separate group sessions for parents and children over a five to six week period, and use individualized plans to increase calcium intake. Participants will be recruited into two groups: a group of healthy children (i.e.,no known chronic disease or previous oral steroid exposure) with no known risk factors, and a group of healthy children with potential risk factors for low bone density (previous
52 Lactose Intolerance
fracture from usual childhood activities, daily refusal, or lactose intolerance, family history of osteoporosis). These two groups will be equally represented in their assignment to BM-NE and UC groups. This latter strategy will be used to determine whether the presence of risk factors influences participant compliance with the programs. We hypothesize that (a) at the end of 36 months the BM-NE group will have increased dietary calcium of at least 300 mg/d in the no-risk BM-NE group compared to those receiving UC, (b) baseline calcium intake and presence of risk factors will be associated with changes in calcium intake over the course of the study, and (c) after controlling for important covariates such as increases in body size and sexual and skeletal maturation, changes in BMD will be associated with calcium intake and physical activity. These findings will help define important behavioral strategies for increasing peak bone mass and prevention of osteoporosis later in life that can be implemented in a short period of time with longlasting effects. Furthermore, it will help quantify the impact of increased dietary calcium on bone density during growth and development with possible identification of the characteristics of children most in need of and responsive to this treatment. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.16 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with lactose intolerance, simply go to the PubMed Web site at PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
16
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www.ncbi.nlm.nih.gov/pubmed. Type “lactose intolerance” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “lactose intolerance” (hyperlinks lead to article summaries): ·
The response to dietary treatment of patients with chronic postinfectious diarrhea and lactose intolerance. Author(s): Lifshitz F, Fagundes-Neto U, Ferreira VC, Cordano A, Ribeiro Hda C. Source: J Am Coll Nutr. 1990 June; 9(3): 231-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2358619&dopt=Abstract
·
Wheat extract and milk mixture as a milk substitute for children with milk intolerance. Author(s): Suthutvoravut U, Tontisirin K, Varavithya W, Valyasevi A, Bjorck I, Dahlqvist A. Source: J Diarrhoeal Dis Res. 1984 September; 2(3): 168-72. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6512217&dopt=Abstract
Vocabulary Builder Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU]
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Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carmine: Coloring matter from the insect Coccus cacti L. It is used in foods, pharmaceuticals, toiletries, etc., as a dye, and also has use as a microscopic stain and biological marker. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Dietetics: The study and regulation of the diet. [NIH] Distention: The state of being distended or enlarged; the act of distending. [EU]
Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH]
Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU]
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Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Propantheline: A muscarinic antagonist used as an antispasmodic, in rhinitis, in urinary incontinence, and in the treatment of ulcers. At high doses it has nicotinic effects resulting in neuromuscular blocking. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Refractory: Not readily yielding to treatment. [EU] Rehydration: The restoration of water or of fluid content to a body or to substance which has become dehydrated. [EU] Skeletal: Pertaining to the skeleton. [EU] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Urinary: Pertaining to the urine; containing or secreting urine. [EU]
Patents 57
CHAPTER 4. PATENTS ON LACTOSE INTOLERANCE Overview You can learn about innovations relating to lactose intolerance by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.17 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with lactose intolerance within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with lactose intolerance. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
Adapted from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
17
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Patents on Lactose Intolerance By performing a patent search focusing on lactose intolerance, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.).
Patent Applications on Lactose Intolerance As of December 2000, U.S. patent applications are open to public viewing.18 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to lactose intolerance: ·
Method for Increasing Lactose Tolerance in Mammals Exhibiting Lactose Intolerance Inventor(s): Ritter, Andrew J. ; (Los Angeles, ca) Correspondence: Andrew J. Ritter; 11778 Stonehenge Lane; Los Angeles; CA; 90077; US Patent Application Number: 20020034496 Date filed: July 1, 1999 Abstract: The method for increasing lactose tolerance in subjects exhibiting lactose intolerance symptoms implements a protocol where the subjects ingest a gradually increasing amount of lactose containing product over a six week period. At various points during the six week period the subject ingests the lactose containing product once a day and then twice a day. The lactose containing product can be in liquid form, such as for example, milk, and is preferably in a powder form which is taken either by ingesting capsules having the lactose powder or in a granular form mixed with water or other non-lactose containing liquid. At the end of the six week period, the subject's tolerance for lactose containing products is substantially increased, with the potential of eliminating the subject's lactose intolerant behavior indefinitely.
18
This has been a common practice outside the United States prior to December 2000.
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Excerpt(s): Lactose Intolerance, or otherwise referred to as lactose maldigestion, is the inability to digest a significant amount of lactose, derived from a deficiency of the lactase enzyme in the small intestines. Lactose is the natural sugar in milk and milk products of all mammals. Lactase is the enzyme which splits the milk sugar lactose into its components (i.e., glucose and galactose), and also breaks down the milk sugar into smaller forms that can be processed into the bloodstream. The lactase enzyme is necessary for mammals to digest lactose. ... There is an important distinction between lactose intolerance and milk allergies. Lactose intolerance is the inability of the body to digest lactose containing products due to a deficiency in the lactase enzyme. A milk allergy, however, is a sensitivity to the protein in milk, which involves the immune system and does not relate to a deficiency of the lactase enzyme. In humans, a milk allergy is usually experienced only by infants. ... Generally, humans develop lactose intolerance from a primary or secondary cause. The primary cause is an onset loss of lactase that is a permanent condition. This occurs at a variable period after the weaning period. The primary cause is also genetically determined. The secondary cause is generally a temporary condition that occurs as a result of another disease or event that damages the lining of the small intestine where lactase is active. This is usually caused by an acute diarrheal disease, parasitic infection, Crohn's disease, celiac disease, gastrointestinal surgery, or the intake of certain medications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with lactose intolerance, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “lactose intolerance” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on lactose intolerance. You can also use this procedure to view pending patent applications concerning lactose intolerance. Simply go back to http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Books 61
CHAPTER 5. BOOKS ON LACTOSE INTOLERANCE Overview This chapter provides bibliographic book references relating to lactose intolerance. You have many options to locate books on lactose intolerance. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on lactose intolerance include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “lactose intolerance” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on lactose intolerance:
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·
Digestive Diseases and Disorders Sourcebook Source: Detroit, MI: Omnigraphics. 2000. 300 p. Contact: Available from Omnigraphics, Inc. 615 Griswold, Detroit, MI 48226. (800) 234-1340. Fax (800) 875-1340. Price: $48.00 plus shipping and handling. ISBN: 0780803272. Summary: This sourcebook provides basic information for the layperson about common disorders of the upper and lower digestive tract. The sourcebook also includes information about medications and recommendations for maintaining a healthy digestive tract. The book's 40 chapters are arranged in three major parts. The first section, Maintaining a Healthy Digestive Tract, offers basic information about the digestive system and digestive diseases, information about tests and treatments, and recommendations for maintaining a healthy digestive system. The second section, Digestive Diseases and Functional Disorders, describes nearly 40 different diseases and disorders affecting the digestive system. These include appendicitis, bleeding in the digestive tract, celiac disease, colostomy, constipation, constipation in children, Crohn's disease, cyclic vomiting syndrome, diarrhea, diverticulosis and diverticulitis, gallstones, gas in the digestive tract, heartburn (gastroesophageal reflux disease), hemorrhoids, hernias, Hirschsprung's disease, ileostomy, indigestion (dyspepsia), intestinal pseudo-obstruction, irritable bowel syndrome (IBS), IBS in children, lactose intolerance, Menetrier's disease, rapid gastric emptying, short bowel syndrome, ulcerative colitis, ulcers, Whipple's disease, and Zollinger Ellison syndrome. The final section offers a glossary of terms, a subject index and a directory of digestive diseases organizations (which includes website and email addresses as available). Material in the book was collected from a wide range of government agencies, nonprofit organizations, and periodicals.
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On The Celiac Condition: A Handbook for Celiac Patients and Their Families. 2nd ed Source: Omaha, NE: Celiac Sprue Association/United States of America, Inc. 1998. 132 p. Contact: Available from Celiac Sprue Association/USA, Inc. P.O. Box 31700, Omaha, NE 68131-0700. (402) 558-0600. Fax (402) 558-1347. Price: $8.00. Summary: Information on celiac sprue is presented to patients with this complex medical disorder. Basic information includes a description of the condition, genetics, diagnosis, treatment, and long-term consequences. Information is discussed regarding all age groups affected by the disease. A gluten-free diet is presented together with recipes, menus, allowable
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foods, sources for obtaining gluten-free products commercially, and the vitamin/food supplement question is addressed. Lactose intolerance, weight problems, pharmaceuticals, food labeling laws and mental health problems are also discussed. Suggestions for airline travel and preparation for hospitalization with celiac sprue are included. A list of resource centers and the most commonly asked questions by people with celiac sprue and their families are included together with a glossary of medical terms relating to the condition. 29 references. ·
Medical Advisor Home Edition: The Complete Guide to Alternative and Conventional Treatments Source: Alexandria, VA: Time-Life Books. 1997. 960 p. Contact: Available from Time-Life Books. 400 Keystone Industrial Park, Dunsmore, PA 18512. Price: $20.00. ISBN: 0783552505. Summary: This book offers information about 300 health problems, ranging from relatively benign conditions to the most serious diseases. There are symptoms charts which name several related problems and help readers decide which ailment entry to look up. Ailment entries provide a more complete list of symptoms, plus guidelines to discern whether the condition is potentially serious or requires a doctor's attention. Each entry describes the ailment and how it affects the body. Next, the entry outlines the underlying causes of the ailment and the tests and procedures a doctor may use to confirm the diagnosis. The treatment segment presents conventional and alternative recommendations for curing the problem or alleviating the symptoms. Most ailment entries conclude with advice on preventive measures that can be used to maintain health. Alternative treatments discussed include bodywork, acupuncture and acupressure, herbal therapies, homeopathy, lifestyle changes, and nutrition and diet. The book begins with a section on emergency medicine. Also included is a visual diagnostic guide, an atlas to the body, a medicine chest section (describing herbs, homeopathic remedies, and over the counter drugs), a glossary, a subject index, a bibliography, and a list of health associations and organizations. Topics related to digestive diseases include abdominal pain, AIDS, allergies, anal bleeding, anal fissure, anorexia nervosa, bad breath, bowel movement abnormalities, bulimia, celiac disease, cholesterol problems, colitis, colorectal cancer, constipation, Crohn's disease, diarrhea, diverticulitis, flu, food poisoning, gallstones, gas and gas pains, gastritis, gastroenteritis, heartburn, hiatal hernia, hiccups, incontinence, indigestion, irritable bowel syndrome, lactose intolerance, lupus, obesity, pancreatic cancer, pancreatic problems, stomach cancer, stomach ulcers,
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swallowing difficulty, trichomoniasis, vomiting, and worms. The book is illustrated with line drawings and full-color photographs. ·
Raising Your Child Without Milk: Reassuring Advice and Recipes for Parents of Lactose-Intolerant and Milk-Allergic Children Source: Rocklin, CA: Prima Publishing. 1996. 374 p. Contact: Available from Prima Publishing. P.O. Box 1260 BK, Rocklin, CA 95677. (916) 632-4400. Price: $16.95; quantity discounts available. ISBN: 0761501312. Summary: Written from a parent's perspective, this book offers guidelines for managing a dairy-free diet for a child. Eleven chapters cover differences between lactose intolerance and milk allergy, concerns about calcium, meal planning at home, feeding a dairy-sensitive child at school or day care, kids' meals in restaurants, shopping tips, medications that contain milk products, dealing with pain, and support groups for patients and parents. The book includes 125 dairy-free recipes. The book also includes detailed resource lists, a bibliography, and a subject index. 104 references.
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Instructions for Patients. 5th ed Source: Philadelphia, PA: W.B. Saunders Company. 1994. 598 p. Contact: Available from W.B. Saunders Company. Book Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 5452522. Fax (800) 874-6418. Price: $49.95. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This paper-bound book presents a number of patient instruction fact sheets. Each fact sheet includes three sections: basic information on signs and symptoms, causes, risk factors, etc.; treatment; and when to contact one's health care provider. Digestive system topics include food allergy, anal fissure, celiac disease, appendicitis, Crohn's disease, constipation, ulcerative colitis, cirrhosis of the liver, cholecystitis or cholangitis, diarrhea, diverticular disease, gallstones, gastritis, hiatal hernia, hemorrhoids, heartburn, irritable bowel syndrome, and lactose intolerance, among others. The fact sheets are designed to be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. The book is available in English or Spanish.
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Adverse Reactions to Food Source: Chicago, IL: American Dietetic Association. 1991. 74 p.
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Contact: Available from American Dietetic Association. 216 West Jackson Boulevard, Chicago, IL 60606-6995. (800) 877-1600, ext. 5000. Fax (312) 899-4899. Price: $8.45 (ADA members); $9.95 (nonmembers). ISBN: 0880910933. Summary: This publication reviews recent advances regarding immunologically mediated reactions to foods, including the definitions, clinical features, testing and diagnostic procedures, dietary management, and medications used to treat these reactions. Also addressed are lactose intolerance and gluten-induced enteropathy, along with reactions to food additives and sweeteners that are sometimes confused with true sensitivity. A separate section addresses concerns in the pediatric population, including cow's milk sensitivity and attention deficithyperactivity disorder. Extensive tables and appendices are included. 9 tables. 137 references.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to lactose intolerance (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
101 Fabulous Dairy-Free Desserts Everyone Will Love: For the Lactose Intolerant, the Dairy-Allergic, and Their Friends and Families by Annette Pia Hall (1998); ISBN: 1581770189; http://www.amazon.com/exec/obidos/ASIN/1581770189/icongroupin terna
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Ce lait qui menace les femmes by Raphaèel Nogier; ISBN: 2268018334; http://www.amazon.com/exec/obidos/ASIN/2268018334/icongroupin terna
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Common Food Intolerances 2: Milk in Human Nutrition and AdultType Hypolactasia (Dynamic Nutrition Research, Vol 3) by S. Auricchio, G. Semenza (Editor) (1993); ISBN: 3805557418; http://www.amazon.com/exec/obidos/ASIN/3805557418/icongroupin terna
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Curing Colic and Lactose Intolerance With Homeopathy by Jana Shiloh; ISBN: 0961920300; http://www.amazon.com/exec/obidos/ASIN/0961920300/icongroupin terna
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Dairy-Free and Delicious by Brenda Davis, et al (2001); ISBN: 1570671249; http://www.amazon.com/exec/obidos/ASIN/1570671249/icongroupin terna
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Dairy-Free Cookbook by Jane Zukin; ISBN: 1559580887; http://www.amazon.com/exec/obidos/ASIN/1559580887/icongroupin terna
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Dairy-Free Cookbook, Fully Revised 2nd Edition : Over 250 Recipes for People with Lactose Intolerance or Milk Allergy by Jane Zukin (2000); ISBN: 0761514678; http://www.amazon.com/exec/obidos/ASIN/0761514678/icongroupin terna
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How to Tolerate Lactose Intolerance: Recipes & A Guide for Eating Well Without Dairy Products by Phyllis Z. Goldberg (1998); ISBN: 0398068690; http://www.amazon.com/exec/obidos/ASIN/0398068690/icongroupin terna
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Lactose Digestion: Clinical and Nutritional Implications by Paige; ISBN: 0801826470; http://www.amazon.com/exec/obidos/ASIN/0801826470/icongroupin terna
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Lactose free foods : a shopper's guide : a carry-along guide and resource for lactose-intolerant consumers ; ISBN: 0964478706; http://www.amazon.com/exec/obidos/ASIN/0964478706/icongroupin terna
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Lactose Intolerance by Merri L. Dobler (1991); ISBN: 0880910976; http://www.amazon.com/exec/obidos/ASIN/0880910976/icongroupin terna
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Lactose Intolerance: A Resource Including Recipes ; ISBN: 0880910143; http://www.amazon.com/exec/obidos/ASIN/0880910143/icongroupin terna
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Lactose-Free Cooking: Recipes for People Sensitive to Dairy Products by Arlene Burlant; ISBN: 096269410X; http://www.amazon.com/exec/obidos/ASIN/096269410X/icongroupi nterna
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Lactose-Free: More Than 100 Delicious Recipes Your Family Will Love (Great Healthy Food) by Lucy Knox, Sarah Lowman (2000); ISBN: 0684872587; http://www.amazon.com/exec/obidos/ASIN/0684872587/icongroupin terna
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Living Well With Lactose Intolerance by Jaime Aranda-Michel, et al; ISBN: 0380806428; http://www.amazon.com/exec/obidos/ASIN/0380806428/icongroupin terna
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Milk is Not for Every Body: Living with Lactose Intolerance by Steve Carper, Robert Kornfield (1996); ISBN: 0452277116; http://www.amazon.com/exec/obidos/ASIN/0452277116/icongroupin terna
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Milk-Free Diet Cookbook: Cooking for the Lactose Intolerant by Jane. Zukin; ISBN: 080695566X; http://www.amazon.com/exec/obidos/ASIN/080695566X/icongroupi nterna
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No Milk Today by Steve Carper; ISBN: 0671620207; http://www.amazon.com/exec/obidos/ASIN/0671620207/icongroupin terna
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No Milk Today: How to Live With Lactose Intolerance by Steve Carper; ISBN: 0671603019; http://www.amazon.com/exec/obidos/ASIN/0671603019/icongroupin terna
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Raising Your Child Without Milk: Reassuring Advice and Recipes for Parents of Lactose-Intolerant and Milk-Allergic Children by Jane Zukin; ISBN: 0761501312; http://www.amazon.com/exec/obidos/ASIN/0761501312/icongroupin terna
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Secrets of Lactose-Free Cooking: Over 150 Delicious Dairy-Free and Lactose-Reduced Recipes-From Breakfast to Dinner by Arlene Burlant (1996); ISBN: 0895297248; http://www.amazon.com/exec/obidos/ASIN/0895297248/icongroupin terna
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The Lactose-Free Cookbook by Sheri Updike (1998); ISBN: 0446673935; http://www.amazon.com/exec/obidos/ASIN/0446673935/icongroupin terna
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The Milk Sugar Dilemma: Living with Lactose Intolerance by Sherlyn Martens, Richard A. Martens (1987); ISBN: 0936741015;
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http://www.amazon.com/exec/obidos/ASIN/0936741015/icongroupin terna ·
What's to Eat? The Milk-Free, Egg-Free, Nut-Free Food Allergy Cookbook by Linda Marienhoff Coss; ISBN: 0970278500; http://www.amazon.com/exec/obidos/ASIN/0970278500/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “lactose intolerance” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:19 ·
Adverse reactions to food. Author: Therese Beaudette; Year: 1991; Chicago, Ill.: American Dietetic Association, c1991; ISBN: 0880910933 http://www.amazon.com/exec/obidos/ASIN/0880910933/icongroupin terna
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Autogenic-Feedback Training: a potential treatment for post-flight orthostatic intolerance in aerospace crews. Author: P.S. Cowings ... [et al.]; Year: 1993; Washington, DC: NASA Headquarters, 1993
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Bacteria fermenting lactose and their significance in water analysis, by Max Levine ... Author: Levine, Max, 1889-; Year: 1921; Ames, Ia., Iowa state college of agriculture and mechanic arts [1921]
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Chemical intolerance: physiological causes and effects and treatment modalities. Author: Robert W. Gardner; Year: 1994; Boca Raton: CRC Press, c1994; ISBN: 0849389267 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0849389267/icongroupin terna
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
19
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Clinical physiology of bed rest. Author: J.E. Greenleaf; Year: 1993; Washington, DC: NASA Headquarters, 1993
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Common food intolerances 2: milk in human nutrition and adult-type hypolactasia. Author: 2nd International Symposium on Common Food Intolerances--Health Risks Due to Lack or Consumption of Milk in Human Nutrition, and Adult-type Hypolactasia, Capri, October 9-1; Year: 1993; Basel; New York: Karger, 1993; ISBN: 3805557418 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3805557418/icongroupin terna
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Detrimental effect of lactose [by] A. P. De Groot & C. Engel. Author: Groot, Antonius Petrus de; Year: 9999; Utrecht, 1957-
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Exercise intolerance and muscle contracture. Author: [edited by] G. Serratrice, J. Pouget, J.-Ph. Azulay, (eds); Year: 1999; Paris; New York: Springer, c1999; ISBN: 2287596690 (softcover) http://www.amazon.com/exec/obidos/ASIN/2287596690/icongroupin terna
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Food intolerance and the food industry. Author: edited by Taraneh Dean; Year: 2000; Boca Raton, FL: CRC Press; Cambridge, England: Woodhead Pub., 2000; ISBN: 0849308534 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0849308534/icongroupin terna
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Food intolerance. Author: Maurice H. Lessof; Year: 1992; London: Chapman & Hall; James & James, 1992; ISBN: 0412448505 http://www.amazon.com/exec/obidos/ASIN/0412448505/icongroupin terna
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Foods, nutrition, and immunity: effects of dairy and fermented milk products: 2nd Bio-Inova. Author: EIBET Workshop, Paris, December 9, 1991 / volume editors, M. Paubert-Braquet, Ch. Dupont, R. Paoletti; Year: 1992; Basel; New York: Karger, 1992; ISBN: 3805556055 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3805556055/icongroupin terna
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From intolerance to indifference: access to opportunity for women physicians, 1870-1925. Author: Jayne Crumpler DeFiore; Year: 1990; [Knoxville, Tenn.?: s.n.], c1990
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Inheritance of selective adult-type lactose malabsorption. Author: Sahi, Timo; Year: 1974; Helsinki [Universitetsforlaget] 1974
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Lactose digestion. Author: edited by David M. Paige, Theodore M. Bayless; Year: 1981; Baltimore: Johns Hopkins University Press, c1981; ISBN: 0801826470 http://www.amazon.com/exec/obidos/ASIN/0801826470/icongroupin terna
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Lactose intolerance: a resource including recipes. Author: Beaudette, Therese; Year: 1985; Chicago: American Dietetic Association, c1985; ISBN: 0880910127 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0880910127/icongroupin terna
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Lactose intolerance: January 1977 through December 1979: 187 citations. Author: prepared by Gale A. Dutcher; Year: 1979; [Bethesda, Md.]: Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health, [1979]
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Lactose intolerance nutrition guide. Author: Merri Lou Dobler; Year: 2002; [Chicago]: American Dietetic Association, 2002; ISBN: 088091307X
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Metabolic syndrome X: convergence of insulin resistance, glucose intolerance, hypertension, obesity, and dyslipidemias--searching for underlying defects. Author: edited by Barbara Caleen Hansen, JoAnne Saye, and Lawrence P. Wennogle; Year: 1999; New York, N.Y.: New York Academy of Sciences, 1999; ISBN: 157331207X (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/157331207X/icongroupi nterna
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Milk intolerances and rejection. Author: editor, J. Delmont; Year: 1983; Basel; New York: Karger, 1983; ISBN: 3805535465 http://www.amazon.com/exec/obidos/ASIN/3805535465/icongroupin terna
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Milk is not for every body: living with lactose intolerance. Author: Steve Carper; foreword by Robert Kornfield; Year: 1995; New York, NY: Facts on File, c1995; ISBN: 0816031274 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0816031274/icongroupin terna
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Nordic Workshop on Lactose Malabsorption, Helsinki, August 26-27, 1972. Author: edited by Leena Hansson and I. P. Palva; Year: 1973; Oulu, Finland: Nordic Council for Arctic Medical Research, 1973
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NTP technical report on the toxicology and carcinogenesis studies of pentaerythritol tetranitrate (CAS no. 78-11-5) with 80% d-lactose monohydrate (PETN, NF) in F344. Author: N rats and B6C3F1 mice (feed studies) / John R. Bucher, study scientist; Year: 1989; Research Triangle Park, NC (P.O. Box 12233, Research Triangle Park 27709): The Program; Springfield, VA: Available for sale from the National Technical Information Service, [1989]
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Overcoming therapeutic challenges: resistance, intolerance, end-points: satellite symposium to the Fifth European Conference on Clinical Aspects and Treatment of HIV Infection, 27 September 1995,
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Copenhagen, Denmark. Author: editors, N. Clumeck, J.M. Lange; Year: 1995; Philadelphia: Rapid Science Publishers, c1995 ·
Respiratory hydrogen excretion as a parameter for sugar malabsorption in children. Author: door Adrianus Cornelis Douwes; Year: 1979; [Groningen, Netherlands?: s.n.], 1979
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Role of neural plasticity in chemical intolerance. Author: edited by Barbara A. Sorg and Iris R. Bell; Year: 2001; New York, N.Y.: New York Academy of Sciences, 2001; ISBN: 1573313084 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1573313084/icongroupin terna
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Specific lactose malabsorption in adults. Author: Eivind GudmandHøyer; Year: 1971; Copenhagen: Fadl's Forlag, 1971; ISBN: 8774370960
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Study on the prevalence and implications of hypolactasia in Surinam's Bushnegro-children. Author: door Jan Zaal; Year: 1977; [Amsterdam: s.n., 1977?]
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WHO's contribution to the World Conference Against Racism, Racial Discrimination, Xenophobia, and Related Intolerance: health and freedom from discrimination. Author: [produced by the World Health Organization, Department of Health and Development, Sustainable; Year: 2001; Geneva: World Health Organization, c2001
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Would eliminating housing market discrimination and White intolerance of Black neighbors substantially reduce residential segregation? Author: C. St. John; Year: 1996; 1996
Chapters on Lactose Intolerance Frequently, lactose intolerance will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with lactose intolerance, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and lactose intolerance using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “lactose intolerance” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on lactose intolerance:
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Coexistent Irritable Bowel Syndrome and Inflammatory Bowel Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 91-94. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 5687281. Fax (905) 522-7839. Email:
[email protected]. Website: www.bcdecker.com. Price: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This second chapter on the coexistence of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as IBD. Irritable bowel syndrome (IBS) is a chronic abdominal symptom complex for which no structural underlying abnormality can be demonstrated. It is a common disorder that affects all age groups with an increased frequency in females. Few if any of the clinical features of IBS can confidently distinguish it from IBD. This chapter focuses on the prevalence of IBS, clinically relevant pathophysiology, and the importance of the patient-physician relationship. The author notes that there are several pathophysiologic alterations found in the small bowel and colon of patients with IBS that could be aggravated or brought to the level of clinical awareness by IBD or its treatment. These alterations include pain or diarrhea after ileo-right colon resection (removal); active proctosigmoiditis; ileal pouch procedures; and an exaggeration of the patient's response to secretagogues, including caffeine and problems with lactose intolerance. The author emphasizes the benefits of explaining to the patient with both IBS and IBD the fact that she or he has two different disorders and that each may cause its own symptoms. Explaining the pathophysiology seems to help the patient adjust medications and understand and accept symptoms caused by meals or by stress. 6 references.
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Dietary Recommendations for Active and Inactive Ulcerative Colitis Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 161-164. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 5687281. Fax (905) 522-7839. Email:
[email protected]. Website:
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www.bcdecker.com. Price: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on dietary recommendations for active and inactive ulcerative colitis (UC) is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and UC, together known as inflammatory bowel disease (IBD). This chapter discusses the role of diet and nutritional support in ulcerative colitis (UC) in which the catabolic effect (breakdown or loss of body tissue) of inflammation, impaired nutrient absorption, and gastrointestinal (GI) dysfunction can rapidly lead to malnutrition. Inactive UC is a chronic disorder and may be associated with malnutrition, specific elemental deficiencies, and specific food intolerances. Patients may not eat enough to meet their nutritional requirements because of anorexia, drug side effects (eg, nausea, headache, and anorexia), food-induced diarrhea, or pain. In lactose intolerant people, production of hydrogen produces bloating, nausea, and flatulence and unabsorbed short-chain fatty acids produce diarrhea. Lactose intolerance may be primary (racial or congenital) or secondary (eg, due to bacterial overgrowth or intestinal mucosal disease or injury). The incidence of UC is not increased in lactose intolerant people, and the incidence of lactose intolerance is not increased in patients with UC. In UC in remission, lactose restriction is important to control symptoms only in those patients documented to have lactose intolerance, presumably on a genetic basis. Active UC involves pathologic and physiologic changes both within the colonic mucosa and systemically. The colonic mucosa is inflamed and associated with loss of fluid, electrolytes, proteins and immunoglobulins, albumin (protein), and hemoglobin (red blood cells). Systemic manifestations of fever and anorexia are associated with reduced oral intake of nutrients. However, the body is in a catabolic state, with increased nutritional requirements and increased energy needs as a result of fever, associated infections, and steroid therapy. In these situations, nutritional support is essential. In such cases, parental or enteral nutrition not only may be of value but may be essential in patient management. 2 tables. 10 references. ·
Celiac Disease Source: in King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 115-124. Contact: Available from Mayo Clinic Health Information. 5505 36th Street, SE, Grand Rapids, MI 49512. (800) 291-1128. Website: www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005046.
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Summary: Celiac disease damages the small intestine and interferes with its ability to absorb certain nutrients from food. People with celiac disease cannot tolerate gluten, a protein found in wheat, barley, rye, and, possibly, oats. This chapter on celiac disease is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. This chapter first reviews the key signs and symptoms of celiac disease, including diarrhea, abdominal gas and bloating, fatigue, weight loss, and stunted growth (in children with celiac disease). The authors review the inheritance of the condition, the various symptoms that may present with celiac disease, and the main treatment, a diet that is completely without gluten (gluten free). The authors encourage readers to learn about food labeling and caution that food processing may need to be considered when determining if a particular food is gluten free. Other sections offer strategies for eating out at restaurants while following a gluten free diet, and for adapting favorite recipes to be gluten free. Sidebars review the differences between celiac disease and similar conditions, the interrelationship between celiac disease and lactose intolerance (difficulty in digesting the sugars present in dairy products), and hidden sources of gluten. 1 figure. ·
Ulcerative Colitis Source: in Stein, S.H. and Rood, R.P. Inflammatory Bowel Disease: A Guide for Patients and Their Families. 2nd ed. Philadelphia, PA: Lippincott-Raven Publishers. 1999. p. 31-38. Contact: Available from Crohn's and Colitis Foundation of America. 386 Park Avenue South, 17th Floor, New York, NY 10016-8804. (800) 9322423. Fax (212) 779-4098. E-mail:
[email protected]. Website: www.ccfa.org. Price: $17.00 for members; $22.00 for nonmembers; plus shipping and handling. ISBN: 0397517718. Summary: This chapter describing ulcerative colitis (UC) is from a text written specifically for people with inflammatory bowel disease (IBD), which is the collective term for ulcerative colitis and Crohn's disease. Ulcerative colitis is an inflammatory disease of the large intestine (the colon), that is characterized by inflammation and ulceration of its inner lining. By contrast, Crohn's disease can affect any area of the gastrointestinal tract, including the small intestine, and there can be areas of normal intestine as well. The author describes the symptoms,
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diagnosis, and complications of UC as well as its medical and surgical treatment and prognosis. Medical treatment can include three major classes of medications: aminosalicylates, corticosteroids, and immunomodulatory medicines (including azathioprine). In addition, avoiding caffeine and lactose (milk sugar) in patients with lactose intolerance can reduce diarrhea in some cases. In addition, bulk forming agents can help decrease the volume of debilitating diarrhea, and antimotility agents can be used to control the diarrhea associated with UC. Surgery is recommended for those patients whose disease is not controllable medically or those who have complications. These can include toxic megacolon and colon cancer, and extraintestinal complications such as anemia, arthritis, skin diseases, certain liver diseases, eye inflammation, and kidney diseases (usually due to dehydration). The course of the disease depends on many factors, including severity, extent, and associated complications. Even though persons with UC may need to take regular medication and may occasionally need to be hospitalized, most continue to lead normal, useful, and productive lives. ·
Postgastrectomy Diet Source: in American Dietetic Association. Manual of Clinical Dietetics. Chicago, IL: American Dietetic Association. 1996. p. 411-417. ..PD. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard, Chicago, IL 60606. (800) 877-1600 or (312) 899-0040. Fax (312) 899-4899. Price: $59.95 for members, $70.00 for nonmembers. ISBN: 0880911530. Summary: This section describing a postgastrectomy diet is from a manual that serves as a nutrition care guide for dietetics professionals, physicians, nurses, and other health professionals. The manual integrates current knowledge of nutrition, medical science, and food to set forth recommendations for healthy individuals and those for whom medical nutrition therapy (MNT) is indicated. The postgastrectomy diet is designed to provide adequate calories and nutrients to support tissue healing and to prevent weight loss and dumping syndrome after gastric surgery. A postgastrectomy diet is used for persons who undergo a surgical procedure involving bypass or excision of the pylori sphincter, resulting in the body's inability to regularly empty the stomach. The text outlines the purpose, use, modifications, and adequacy of the diet. The section also notes the related physiology, discussing dumping syndrome, lactose intolerance, hypoglycemia, steatorrhea, and vitamin and mineral deficiencies. A brief sample menu is included. 2 tables. 11 references. (AA-M).
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Gastrointestinal System Source: in Kelly, R.B., ed. Family Health and Medical Guide. Dallas, TX: Word Publishing. 1996. p. 169-200. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Price: $30.00 for members; $35.00 for nonmembers; plus shipping and handling. ISBN: 0849908396. Summary: This chapter on the gastrointestinal system is from a family health and medical guide. The chapter first describes the anatomy and function of the gastrointestinal tract, including the mouth, esophagus, stomach, small intestine, pancreas, gallbladder, liver, and large intestine. The chapter then covers problems of the gastrointestinal system, such as anal abscesses, fissures, and itching; appendicitis; bowel blockage; carcinoid tumors; colon polyps; colorectal cancer; constipation; Crohn's disease; dehydration; diarrhea; diverticulosis and diverticulitis; esophageal cancer and varices; gas; gastroenteritis; heartburn; hemorrhoids; hernias (hiatal and inguinal); ileus; irritable bowel syndrome (IBS); malabsorption (including celiac disease, lactose intolerance, pernicious anemia, postsurgical malabsorption, and Whipple's disease); peritonitis; proctitis; stomach cancer; ulcers; ulcerative colitis; and vomiting. For each topic, the authors discuss symptoms, diagnostic tests, treatment options, and prevention. Numerous sidebars cover home remedies for constipation; symptoms of a serious bowel problem; ways to prevent dehydration in adults; the BRAT (bananas, rice, apples, toast) diet; ways to prevent esophageal cancer, gas, and heartburn; hiccups; and home remedies for irritable bowel, as well as when to call the doctor about nausea or vomiting. 10 figures.
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Gastrointestinal Disease in the Aged Source: in Reichel, W., et al., eds. Care of the Elderly: Clinical Aspects of Aging. 4th ed. Baltimore, MD: Williams and Wilkins. 1995. p. 198-205. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 4478438 or (410) 528-8550. Price: $69.00 (as of 1996). ISBN: 0683072099. Summary: This chapter on gastrointestinal (GI) disease in the aged is from a text on the clinical aspects of aging. This chapter covers problems associated with the esophagus, the stomach, the small bowel and pancreas, and the colon and rectum; liver disease; biliary disease; and pancreatic disease. Specific conditions discussed include appendicitis, heartburn, dysphagia, drug-induced gastritis, gastroparesis, lactose
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intolerance, inflammatory bowel disease, diverticulosis, colon cancer, constipation, fecal incontinence, irritable bowel syndrome, jaundice, hepatitis, gallstones, pancreatitis, and pancreatic cancer. 1 table. 22 references.
General Home References In addition to references for lactose intolerance, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Digestive System (21st Century Health and Wellness) by Regina Avraham; Library Binding (February 2000), Chelsea House Publishing (Library); ISBN: 0791055264; http://www.amazon.com/exec/obidos/ASIN/0791055264/icongroupinterna · American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
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Vocabulary Builder Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholecystitis: Inflammation of the gallbladder. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Gastritis: Inflammation of the stomach. [EU]
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Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatitis: Inflammation of the liver. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH]
Ileus: Obstruction of the intestines. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Megacolon: An abnormally large or dilated colon; the condition may be congenital or acquired, acute or chronic. [EU]
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Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Orthostatic: Pertaining to or caused by standing erect. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Reflux: A backward or return flow. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU]
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CHAPTER 6. MULTIMEDIA ON LACTOSE INTOLERANCE Overview Information on lactose intolerance can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on lactose intolerance. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on lactose intolerance is the Combined Health Information Database. You will need to limit your search to “video recording” and “lactose intolerance” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “lactose intolerance” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on lactose intolerance:
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When Milk Doesn't Do a Body Good Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1996. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. Price: $19.95 plus shipping and handling; bulk copies available. Order number 032096A. Summary: Lactose, the sugar component of milk, is made of glucose and galactose. The intestine cannot digest complex sugar, so the body needs the enzyme lactase to break lactose into these simpler sugars. Without adequate lactase levels, symptoms of lactose intolerance can become problematic. This videotape is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Mary Lee and featuring gastroenterologist Mark Lloyd, the common symptoms, diagnosis, and management of lactose intolerance are covered. Dr. Lloyd explains why some people cannot digest milk, defines lactose intolerance, notes who is most affected, and reviews treatment options. Rarely, an infant is born with no lactase; these few children become sick early in life and are usually diagnosed quickly. However, most humans (and other mammals) have no problems with milk in the early years. About 75 percent of the world's population has some problems with lactose; levels vary by ethnic group. The symptoms of lactose intolerance include stomach rumbling and bloating, gas (flatulence), and diarrhea. Dr. Lloyd reviews the differences between lactose intolerance and milk allergy, which is an immunologic reaction. The program then focuses on the diagnosis and management of lactose intolerance. Lactose withdrawal (removing milk and milk products from the diet) or lactose tolerance testing (blood sugar tests and breath hydrogen tests) are used for diagnosis; sometimes biopsy is indicated. The program lists foods high in lactose and offers readers suggestions for dietary modification and the use of lactase supplements. The program concludes by referring viewers to the National Digestive Diseases Information Clearinghouse (NDDIC).
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Barbershop Talk: Benny's Advice on Healthy Eating: A Nutrition Video for the Black Community Source: Southampton, PA: Dairy Council, Inc. 199x. (videocassette with leader's guide, participant cards, and education materials). Contact: Available from Dairy Council, Inc. 1225 Industrial Highway, Southampton, PA 18966-4010. (215) 322-0450. Price: $15 for video and all
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instructional materials. Video alone available for $12. Additional Leader's Guides and participant cards also available separately. Summary: This nutrition videotape on health targets black males. The videotape shows a group of African American men in an everyday setting talking about nutrition and health. Topics include high blood pressure, controlling dietary fats, lactose intolerance, the basic four food groups, soul food, and weight control. The packet includes the videotape, a leader's guide, 25 participant's cards, and Dairy Council education materials. The materials focus on the prevention of common health problems in this population, notably hypertension and diabetes.
Bibliography: Multimedia on Lactose Intolerance The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in lactose intolerance (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on lactose intolerance. For more information, follow the hyperlink indicated: ·
Alban's modified Snyder test. Source: College of Dentistry, University of Florida; Year: 1971; Format: Slide; [Gainesville, Fla.]: The College: [for loan by the J. Hillis Miller Health Center, Learning Resource Center], 1971
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Cholecystitis; pain: RUQ; clinical view of cholecystitis. Source: Trainex Corporation; Year: 1977; Format: Filmstrip; Garden Grove, Calif.: Trainex, c1977
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Controversies in heart failure. Source: with Jay N. Cohn, Spencer H. Kubo, and Maria Teresa Olivari; Year: 1989; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1989
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Differentiation of enteric pathogens by TSI and LIA. Source: produced by the National Medical Audiovisual Center for Laboratory Training and Consultation Division, Bureau of Laboratories, Center for Disease Control; Year: 1979; Format: Videorecording; [Atlanta]: Center for Disease Control, 1979
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Digestion and absorption of carbohydrates. Source: Thomas Trainer, Ronald Picoff, David Duffell; produced at the ASCP Educational Center; Year: 1972; Format: Slide; [Chicago: American Society of Clinical Pathologists, 1972]
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Digestion. Source: a presentation of Films for the Humanities & Sciences; produced for Discovery Health Channel by Big Rock Productions; Year: 2002; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2002
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Enteral feeding tubes. Source: produced by the College of Nursing, Brigham Young University; Year: 1990; Format: Videorecording; [Provo, Utah]: The University, c1990
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Food sensitivities : allergy & intolerance. Source: Meridian Education Corporation; Year: 2000; Format: Videorecording; Bloomington, IL: Meridian Education, c2000
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Gastroenterology . Year: 2001; Format: Electronic resource; Nashville, TN: HealthStream, 2001
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Gene regulation. Source: Leonard Malkin; Year: 1994; Format: Electronic resource; [United States]: Helix Educational Software, [1994?]
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Genetic regulation in bacteria. Source: author, Thomas I. Baker; developed and produced by Biomedical Communications, University of New Mexico, School of Medicine; Year: 1980; Format: Slide; [Washington]: American Society for Microbiology, c1980
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Hyperlipidemia. Source: Elaine B. Feldman, Terrence T. Kuske; Year: 1974; Format: Slide; New York: Medcom, c1974
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Isolation and identification of shigellae. Source: a National Medical Audiovisual Center production; [presented by] the U.S. Department of Health, Education, and Welfare, Public Health Service; Year: 1968; Format: Motion picture; United States: The Center, 1968
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Lac operon. Source: COMPress; Year: 1988; Format: Electronic resource; Fairfield, CT: Queue, c1988
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Lactase deficiency and lactose tolerance test : laboratory tests for malabsorption. Source: Thomas Trainer, Ronald Picoff, David Duffell; produced at the ASCP Educational Center; Year: 1972; Format: Slide; [Chicago: American Society of Clinical Pathologists, c1972]
·
Lactose intolerance. Source: McMaster University, Health Sciences; Year: 1978; Format: Slide; [Hamilton, Ont.]: The University, c1978
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Latex hypersensitivity : the most common cause of anaphylaxis in the OR today. Source: [presented by] the Emory Medical Television Network, Emory University School of Medicine of the Robert W.
Multimedia 85
Woodruff Health Sciences Center; Year: 1995; Format: Videorecording; Atlanta, GA: The University, [1995] ·
Osmotic diarrhea & carbohydrate intolerance. Source: American Gastroenterological Association, in cooperation with the National Library of Medicine, National Medical Audiovisual Center; Year: 1978; Format: Slide; Atlanta: The Center, 1978
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Pathophysiology of diarrhea : an approach to therapy. Source: Eaton [Laboratories]; Year: 1973; Format: Motion picture; Norwich, N. Y.: Eaton: [for loan by Norwich-Eaton Pharmaceuticals, Film Library], 1973
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Pathophysiology of diarrhea. Source: American Gastroenterological Association; Year: 1979; Format: Slide; [Thorofare, N. J.]: The Association; [Timonium, Md.: for sale by Milner-Fenwick], c1979
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Patient interview no. 5. Source: University of Washington; Year: 1973; Format: Videorecording; Seattle: The University, 1973
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Preparing pharmaceutical powders and capsules. Source: U. S. Army Medical Field Service School; Year: 1969; Format: Videorecording; Fort Sam Houston, Tex.: Academy of Health Sciences, 1969
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Regulation of protein synthesis : the operon hypothesis. Source: Terence Murphy; Year: 1978; Format: Slide; El Cerrito, CA: Biology Media, c1978
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Sexual identity issues in adolescents. Source: Robert J. Bidwell, Robert W. Deisher; Year: 1991; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1991
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Unusual and fastidious gram-negative aerobic bacteria. Source: Malcolm Slifkin; Year: 9999; Format: Slide; [Westport, Conn.]: MEDED, c1979-
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When milk is dangerous. Source: David J. Gerrick; Year: 1979; Format: Slide; Lorain, OH: Dayton Lab, c1979
Vocabulary Builder Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol,
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particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Pathogen: Any disease-producing microorganism. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]
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CHAPTER 7. PERIODICALS AND NEWS ON LACTOSE INTOLERANCE Overview Keeping up on the news relating to lactose intolerance can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on lactose intolerance. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover lactose intolerance beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on lactose intolerance is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “lactose intolerance” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Survey Reveals Confusion About Dairy Digestion Problems; Some May Be Denying Themselves the Health (and Taste) Benefits of Dairy Summary: Ft. Washington, Pa., July 17 /PRNewswire/ -- A vast majority of Americans claims to know about lactose intolerance, yet more than half of them mistakenly believe that the only way to handle their difficulties digesting dairy is to avoid dairy altogether, a new poll released today shows. "Perpetuating myths like these means that Americans often wind up depriving themselves or their loved ones of the health benefits and the sheer delight of dairy," said Laura Brainin-Rodriguez, MPH, MS, RD, and nutritionist at San Francisco Department of Public Health. "Dairy in the diet is essential to fend off osteoporosis and possibly other diseases." The survey of 1,008 adults, sponsored by McNeil Nutritionals, showed that 81 percent of Americans say they know what lactose intolerance is. However, among those who tout awareness, more than half (57%) believe that someone with this condition must avoid dairy products, according to the McNeil survey. Furthermore, one third (33 percent) said there is a difference between lactose intolerance and difficulty digesting dairy products. Another one third (35 percent) said they did not know. Only one third (31%) correctly answered that the two conditions are synonymous, and nearly two in 10 Americans who say that they do not know what lactose intolerance is tend to be men, the McNeil survey showed. Difficulty digesting dairy is a condition that occurs when a person does not produce enough of the lactase enzyme to digest all of the lactose (milk sugar) that is eaten. When too much undigested lactose reaches the large intestine, it can cause bloating, cramps, gas or diarrhea.
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In fact, the condition is so common that it is believed to affect 75 percent of the world's population and three out of every 10 Americans. It is particularly prevalent among some cultures, affecting 50 percent of Hispanics, 80 percent of African Americans and over 90 percent of Asian Americans. The good news is that lactose intolerance is easy to manage. While it is not possible to improve the body's ability to produce lactase, the symptoms can be controlled without having to sacrifice dairy foods and their many health benefits. "Although not everyone who has dairy digestive problems develops symptoms, those who do usually notice gastrointestinal discomfort between 30 minutes and two hours after consuming food or drinks containing lactose," explains Brainin-Rodriguez. "But with minimal effort, the discomfort associated with this can be easily minimized or eliminated altogether without giving up the benefits of dairy." For most people, identifying dairy products is easy. However, it becomes more problematic when faced with "hidden dairy" that may be found in foods not considered milk or milk-based. Because lactose provides good texture, binds water and acts as carrier for color, it is sometimes added to baked and processed foods. For more information on determining if symptoms are related to dairy digestion difficulties, ask your doctor or visit http://www.lactaid.com. Tips for those who have trouble digesting dairy: -- space small amounts of dairy items several hours apart; -- eat other foods along with milk-based ones; -- choose hard or aged cheeses like cheddar or Swiss (which contain less lactose than some other cheeses); -- opt for yogurt with active cultures (the cultures contain enzymes that digest lactose on their own); -- use lactose-free milk and use supplements, such as Lactaid, which when taken with dairy foods make lactose easier to digest.
McNeil Nutritionals, the marketers of Lactaid, is a division of McNeil PPC, Inc., a Johnson & Johnson company, and is headquartered in Fort Washington, PA.
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Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to lactose intolerance. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “lactose intolerance” (or synonyms). The following was recently listed in this archive for lactose intolerance: ·
Two DNA variants associated with lactose intolerance Source: Reuters Medical News Date: January 14, 2002 http://www.reuters.gov/archive/2002/01/14/professional/links/20020 114epid001.html
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Gene variation found for lactose intolerance Source: Reuters Health eLine Date: January 14, 2002 http://www.reuters.gov/archive/2002/01/14/eline/links/20020114elin 007.html
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Low-lactose diet does not benefit IBS patients with lactose intolerance Source: Reuters Medical News Date: March 26, 2001 http://www.reuters.gov/archive/2001/03/26/professional/links/20010 326clin011.html
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Gene therapy effective for lactose intolerance in animals Source: Reuters Medical News Date: October 02, 1998 http://www.reuters.gov/archive/1998/10/02/professional/links/19981 002scie003.html
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Gene therapy for lactose intolerance Source: Reuters Health eLine Date: September 29, 1998 http://www.reuters.gov/archive/1998/09/29/eline/links/19980929elin 009.html
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Lactose Intolerance Is "Overrated" Source: Reuters Medical News Date: July 06, 1995 http://www.reuters.gov/archive/1995/07/06/professional/links/19950 706clin003.html
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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “lactose intolerance” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about. Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “lactose intolerance” (or synonyms). If you know the name of a company that is relevant to lactose intolerance, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “lactose intolerance” (or synonyms).
Newsletters on Lactose Intolerance Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “lactose intolerance.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “lactose intolerance” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
New Testing Techniques for Irritable Bowel Syndrome Source: Newsletter for People with Lactose Intolerance and Milk Allergy. p. 3-4. Spring 1993. Contact: Available from Newsletter for People with Lactose Intolerance and Milk Allergy. P.O. Box 3129, Ann Arbor, MI 48106-3129.\ (313) 5729134. Summary: This brief article, from a newsletter for people with lactose intolerance and milk allergy, reports on new testing techniques available for irritable bowel syndrome (IBS). Topics include the various etiologic agents possibly responsible for IBS; the traditional diagnostic methods used to confirm IBS; and the new test, called a bowel scintiscan, that reveals gaps in the emptying process of the large intestine. These gaps indicate areas of the bowel that function abnormally, therefore demonstrating the presence of IBS. The article notes that the test is still experimental and is only available through the Mayo Clinic in Rochester, Minnesota.
·
Food Additives-Are They Hidden Milk? Source: Newsletter for People with Lactose Intolerance and Milk Allergy. Spring 1990. 2 p.
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Contact: Available from Newsletter for People with Lactose Intolerance and Milk Allergy. P.O. Box 3129, Ann Arbor, MI 48106-3129. (313) 5729134. Summary: This brief article, from a newsletter for people who have lactose intolerance and milk allergy, discusses food additives and how to determine if food additives contain milk or milk products. The bulk of the article is an alphabetical list of chemical names, with a 'yes or no' column denoting whether the chemical contains milk. ·
Aiding Calcium Absorption Source: Newsletter for People with Lactose Intolerance and Milk Allergy. Summer 1990. 2 p. Contact: Available from Newsletter for People with Lactose Intolerance and Milk Allergy. P.O. Box 3129, Ann Arbor, MI 48106-3129. (313) 5729134. Summary: This article, from a newsletter for people who have lactose intolerance or milk allergy, discusses ways to aid calcium absorption. Topics include the body's need for calcium, getting calcium from foods or from supplements, the role of calcium in preventing disease, the need for calcium supplements for people who cannot eat dairy foods, ways to aid calcium absorption in the body, and finding a balance of foods and supplements to best meet the body's need for calcium. The article concludes with the recommendation for annual calcium level checks.
·
Nursing the Lactose Intolerant or Milk Allergic Infant Source: Newsletter for People with Lactose Intolerance and Milk Allergy. Fall 1989. 1 p. Contact: Available from Newsletter for People with Lactose Intolerance and Milk Allergy. P.O. Box 3129, Ann Arbor, MI 48106-3129. (313) 5729134. Summary: This brief article, from a newsletter for people who have lactose intolerance or milk allergy, discusses nursing the lactose intolerant or milk allergic infant. Topics include human breast milk versus cow's milk; problems for premature infants; alactasia; the use of soymilk, predigested formula, or lactase-treated breastmilk; allergic reactions to soymilk, and the importance of discussing nursing choices with a health care provider.
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Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “lactose intolerance” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on lactose intolerance: ·
Dietary Factors in Gastrointestinal Diseases Source: Networking News. 20(4): 1, 5, 10. Summer 1999. Contact: Available from Nutrition Education for the Public. ADA/DPG 52, Bill Evers, 2971 Soldiers Home Road, West Lafayette, IN 47906-1660. Summary: This newsletter article reviews the role of dietary factors in gastrointestinal diseases. Many factors have been implicated to produce worsening of symptoms of functional gastrointestinal disorders (FGID), such as irritable bowel syndrome (IBS), including stress and diet. The author discusses several specific diseases that are associated with adverse reactions to food. The common complaints that are associated with reactions to food are: bloating, heartburn, dyspepsia, excessive gas, diarrhea, and constipation. Some of these diseases (gastroesophageal reflux disease, celiac disease, food allergies, and lactose intolerance) are associated with specific dietary therapies that improve symptoms; each is summarized briefly. The author also discusses a rare syndrome, called eosinophilic gastroenteritis, which is treated with prednisone therapy. All of these diseases have characteristics that differentiate them from functional GI disorders (those without a clear underlying pathology). The author notes that a symptoms diary collected over 2 to 3 weeks can help determine the relationship of the symptoms to foods. Many individuals with FGID believe that specific foods are responsible for their symptoms, yet no clear resolution of symptoms occurs when the offending foods are eliminated. An elimination diet should be performed with the help of a health professional, since unmonitored elimination diets can produce malnutrition. 8 references.
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·
Dietary Strategies for Coping with the Gastrointestinal Discomforts of Cancer Therapy Source: Intestinal Fortitude. 8(4): 3. 1998. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888. Summary: Many patients experience gastrointestinal discomfort as a result of cancer therapy. This brief newsletter article offers strategies for coping with these discomforts. The author recommends tips for six problems: nausea and vomiting, lactose intolerance, heartburn, constipation, diarrhea and cramping, and intestinal gas. In each section, the author provides specific strategies and foods to try. Strategies include eating small amounts of food, increasing fiber and fluid intake, avoiding potentially irritating foods (especially caffeine-containing products and alcohol), and undertaking light exercise. The author encourages readers to try the various suggestions and determine what succeeds in each individual situation.
·
Toddler's Diarrhea Source: Newsletter for People With Lactose Intolerance and Milk Allergy. p. 9-10. December-January 1995-1996. Contact: Available from Newsletter for People With Lactose Intolerance and Milk Allergy. P.O. Box 3129, Ann Arbor, MI 48106-3129. (313) 5729134. Summary: This newsletter article presents information about toddlers' diarrhea, a common type of chronic diarrhea in children. Topics include how toddlers' diarrhea differs from other forms of diarrhea, the need for continued fluids or oral rehydration therapy, possible contributing factors, the role of food allergy in diarrhea, and problems with diarrhea in day care centers. The author provides parents with specific suggestions for managing and preventing toddlers' diarrhea.
·
History of Lactose Intolerance Source: Newsletter for People with Lactose Intolerance and Milk Allergy. p. 1-3. June 1995. Contact: Available from Newsletter for People with Lactose Intolerance and Milk Allergy. P.O. Box 3129, Ann Arbor, MI 48106-3129. (313) 5729134. Summary: This newsletter article familiarizes readers with the history of lactose intolerance. Topics include the recent acceptance of lactose intolerance as a legitimate diagnosis; early animal studies on lactase
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enzyme activity; primary lactose intolerance; differences in lactose tolerance among various ethnic groups; the impact of dairying on the consumption of milk; the adaptation hypothesis versus the cultural historical hypothesis; and questions regarding lactase enzyme production and lactose intolerance. ·
Urgent Diarrhea: A Gut Reaction Source: Intestinal Fortitude. 6(1): 1-3, 15. Summer 1995. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888. Summary: This newsletter article explores the problem of urgent diarrhea. Topics include the role of diet, including lactose intolerance and foods to avoid; beverages; eating behaviors; drug therapy; the gastrocolic reflex; the neurocolic reflex; the use of behavior modification to manage the problem of urgent diarrhea; and finding resources for additional assistance with this problem. The author provides practical suggestions for managing everyday situations affected by diarrhea.
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Marketers Milk Misconceptions on Lactose Intolerance Source: Tufts University Diet and Nutrition Letter. 12(10): 4-7. December 1994. Summary: This newsletter article reviews recent advertising for products designed to help people who are lactose intolerant use dairy products. The author contends that any reported rise of lactose intolerance probably is not a true epidemic, but the result of an increase in product marketing. Topics include definitions of lactose intolerance; intolerance versus maldigestion; research studies; cultural influences; diagnostic tests, including self-test kits promoted by the manufacturer of lactosereduced milk and pills that contain the enzyme necessary for digesting milk sugar; transitory lactose intolerance due to illness; dietary suggestions; food labeling; lactose in prescription and over-the-counter medications; and milk allergy.
Academic Periodicals covering Lactose Intolerance Academic periodicals can be a highly technical yet valuable source of information on lactose intolerance. We have compiled the following list of periodicals known to publish articles relating to lactose intolerance and which are currently indexed within the National Library of Medicine’s
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PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on lactose intolerance published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on lactose intolerance: ·
Archives of Disease in Childhood. (Arch Dis Child) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar chives+of+Disease+in+Childhood&dispmax=20&dispstart=0
·
Journal of Tropical Pediatrics. (J Trop Pediatr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Tropical+Pediatrics&dispmax=20&dispstart=0
·
The American Journal of Clinical Nutrition. (Am J Clin Nutr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+American+Journal+of+Clinical+Nutrition&dispmax=20&dispstart=0
Vocabulary Builder Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU]
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CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.20 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:21 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 21 See http://www.nlm.nih.gov/databases/databases.html. 20
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·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat lactose intolerance, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and lactose intolerance using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “lactose intolerance” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with lactose intolerance. The following is a sample result:
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·
Screening Older Americans' Nutritional Health: Current Practices and Future Possibilities. Executive Summary Source: Washington, DC, Nutrition Screening Initiative, 24 p., February 1991. Contact: Nutrition Screening Initiative, 2626 Pennsylvania Avenue, NW., Suite 301, Washington, DC 20037. (202) 625-1662. Summary: Screening Older Americans' Nutritional Health: Current Practices and Future Possibilities is an executive summary of a review of existing literature concerning aging and nutrition. The review examines the prevalence of malnutrition among older Americans and the characteristics of aging. It describes the negative impact of malnutrition on ability to function independently and on mental and physical health. Dietary patterns affect the incidence of atherosclerotic disease, hypertension, obesity, some forms of cancer, osteoporosis, diabetes mellitus, hepatobiliary disease, alcoholism and dental caries. Inappropriate dietary intakes may exacerbate existing conditions (e.g., diabetes mellitus, advanced renal insufficiency, hypercholesteremia, certain forms of hypertension, constipation, gastrointestinal problems due to lactose intolerance, and congestive heart failure). The report addresses specific problems and chronic diseases associated with malnutrition or affecting an individual's nutritional status, describes effective nutrition screening techniques and interventions, and outlines recommendations for a more standard approach to nutrition screening. It also highlights gaps in the present knowledge of nutrition and aging that inhibit progress and considers needed improvements in the science base, in medical and health care practices, and in public policy.
·
Screening Older Americans' Nutritional Health: Current Practices and Future Possibilities Source: Washington, DC, Nutrition Screening Initiative, 136 p., February 1991. Contact: Nutrition Screening Initiative, 2626 Pennsylvania Avenue, NW., Suite 301, Washington, DC 20037. (202) 625-1662. Summary: Screening Older Americans' Nutritional Health: Current Practices and Future Possibilities reviews existing literature concerning aging and nutrition. The report examines the prevalence of malnutrition among older Americans and the characteristics of aging. It describes the negative impact of malnutrition on the ability to function independently and on mental and physical health. Dietary patterns affect the incidence of atherosclerotic disease, hypertension, obesity, some forms of cancer, osteoporosis, diabetes mellitus, hepatobiliary disease, alcoholism and
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dental caries. Inappropriate dietary intakes may exacerbate existing conditions (e.g., diabetes mellitus, advanced renal insufficiency, hypercholesteremia, certain forms of hypertension, constipation, gastrointestinal problems due to lactose intolerance, and congestive heart failure). The report addresses specific problems and chronic diseases that are associated with malnutrition or that affect an individual's nutritional status, describes effective nutrition screening techniques and interventions, and outlines recommendations for a more standard approach to nutrition screening. The document highlights gaps in current knowledge of nutrition and aging that inhibit progress and notes needed improvements in the science base, medical and health care practices, and public policy. 7 tables. ·
Good Nutrition for People With HIV Contact: Channing L. Bete Company Incorporated, 200 State Rd, South Deerfield, MA, 01373-0200, (800) 477-4776, http://www.channingbete.com. Summary: This brochure, written for individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), discusses good nutrition. The brochure identifies nutritional concerns for individuals with HIV/AIDS and provides dietary advice for symptom management of diarrhea, nausea and vomiting, sores in the mouth and/or throat, fatigue, gas/bloating, lactose intolerance, weight loss, and digestion problems. It provides instructions on maintaining sanitary conditions around food preparation. The brochure advises individuals with HIV/AIDS to get nutritional advice from their health care providers, to build support networks, and to keep their medical appointments.
·
Managing Your Child's Eating Problems During Cancer Treatment Source: Bethesda, MD: National Cancer Institute (NCI), National Institutes of Health (NIH). March 1994. 33 p. Contact: Available from National Cancer Institute (NCI). Publications Ordering Service, P.O. Box 24128, Baltimore, MD 21227. (800) 422-6237. TTY (800) 332-8615. Fax (301) 330-7968. Website: rex.nci.nih.gov. Price: Single copy free. NIH Publication Number 94-2038. Summary: This booklet contains a variety of ideas that have helped parents cope with their children's eating problems related to cancer treatment. The author describes the nutrition problems that may be associated with different cancer treatments and lists simple steps for the home care management of these problems. The booklet offers strategies
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for coping with the side effects of cancer therapy, including loss of appetite, sore mouth or throat, changed sense of taste, dry mouth, nausea, vomiting, diarrhea, constipation, weight gain, tooth decay, and lactose intolerance. A final section offers suggestions for increasing the child's intake of protein and calories. The booklet concludes with a glossary of terms and definitions related to diet, nutrition, and cancer treatment. The booklet also provides a brief description of the Cancer Information Service (800-4-CANCER) and the American Cancer Society (800-227-2345). 4 tables. ·
Why Does Milk Bother Me? Source: Bethesda, MD: National Digestive Diseases Information Clearinghouse (NDDIC). 1998. 13 p. Contact: Available from National Digestive Diseases Information Clearinghouse (NDDIC). 2 Information Way, Bethesda, MD 20892-3560. (800) 891-5389 or (301) 654-3810. Fax (301) 907-8906. E-mail:
[email protected]. Price: Single copy free; additional copies available. Summary: This brochure uses nontechnical language to describe lactose intolerance and explains how to manage it. Lactose intolerance refers to the problems with digesting foods containing lactose, the sugar found in milk and foods made with it. The brochure explains what happens when people do not have enough lactase enzyme in their bodies to digest lactose normally. The brochure outlines the symptoms of lactose intolerance (abdominal pain, gas, diarrhea, bloating or swelling in the stomach), the diagnostic tests used to confirm lactose intolerance (blood, breath, and stool tests), and recommendations for avoiding lactose in foods. One section helps readers determine whether a particular food contains lactose by listing the synonyms for milk and milk products found on food labels. The brochure discusses the use of pills or lactase drops to help digest lactose, and the importance of getting adequate calcium in a diet that does not include dairy products. Each point made in the text is illustrated with a corresponding line drawing or graphic. The brochure concludes with a brief description of the National Digestive Diseases Information Clearinghouse, an organization that provides information to people with digestive disorders and to their families, health care professionals, and the public. The brochure is also available online.
·
Understanding Food Allergy Source: Washington, DC: International Food Information Council Foundation. 1998. [4 p.].
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Contact: Available from International Food Information Council Foundation. 1100 Connecticut Avenue, NW, Suite 430, Washington, DC 20036. (202) 296-6540. Price: Single copy free. Summary: Food allergy is a reaction of the body's immune system to something in a food, usually a protein. This brochure is intended for consumer and patient education and addresses the basics of food allergy, food intolerance, and other food sensitivities. Written in a question and answer format, the brochure discusses the foods that tend to cause food allergy, the symptoms, anaphylaxis, other reactions or sensitivities to foods (not allergies), diagnosis, sensitivity to food additives, and ways to avoid life-threatening food allergy situations. The eight most common food allergens are milk, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish. Common symptoms of food allergy include skin irritations, gastrointestinal symptoms (nausea, vomiting, diarrhea), and respiratory symptoms such as sneezing, runny nose, and shortness of breath. Food intolerance is an adverse reaction to a food substance or additive that involves digestion or metabolism but does not involve the immune system (e.g., lactose intolerance). Food idiosyncrasy is an abnormal response to a food or food substance that also does not involve the immune system. Sulfite sensitivity or sulfite-induced asthma is an example of a food idiosyncrasy that affects a small number of people. Diagnosis is based on a thorough medical history, the analysis of a food diary, and several tests, including skin-prick tests, RAST tests (blood test), and food challenges. ·
Dietary Suggestions: For Lactose-Controlled Diet Source: Rochester, MN: Mayo Clinic, Patient and Health Education Center. 1991. 2 p. Contact: Available From Mayo Clinic,Patient and Health Education Center. 200 First Street, SW, Rochester, MN 55905. (507) 284-2511. Price: $0.80 plus shipping and handling (for health care professionals). Order Number MC122/R191. Summary: This patient education brochure offers dietary guidelines for individuals who have lactose intolerance. Topics include dietary recommendations, lactose-free foods, low-lactose foods, and high-lactose foods. The brochure stresses that individual tolerance to lactose varies and that patients should experiment to determine their own level of tolerance. The brochure concludes with blank spaces for the listing of health care providers and phone numbers.
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The NLM Gateway22 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.23 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.24 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “lactose intolerance” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 343735 Books / Periodicals / Audio Visual 2563 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349783
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 24 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 22 23
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HSTAT25 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.26 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.27 Simply search by “lactose intolerance” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists28 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.29 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.30 This site has new Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 27 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 28 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 29 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 30 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext 25 26
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articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Lactose Intolerance With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to lactose intolerance. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).31 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “lactose intolerance” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for lactose intolerance: ·
Hypolactasia, Adult Type Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?223100
·
Lactase Deficiency, Congenital Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?223000
·
Lactose Intolerance, Congenital Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?150220 Genes and Disease (NCBI - Map)
The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
31
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National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
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Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in
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the drop box next to “Search.” In the box next to “for,” enter “lactose intolerance” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database32 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database33 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “lactose intolerance” (or synonyms) into the search box, and review the Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 33 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 32
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results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to nonprofessionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in lactose intolerance (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Blackwell’s Primary Care Essentials: Gastointestinal Disease by David W. Hay; Paperback, 1st edition (December 15, 2001), Blackwell Science Inc; ISBN: 0632045035; http://www.amazon.com/exec/obidos/ASIN/0632045035/icongroupinterna · Gastrointestinal Problems by Martin S. Lipsky, M.D. (Editor), Richard Sadovsky, M.D. (Editor); Paperback - 194 pages, 1st edition (August 15, 2000), Lippincott, Williams & Wilkins Publishers; ISBN: 0781720540; http://www.amazon.com/exec/obidos/ASIN/0781720540/icongroupinterna · Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (Editor); Paperback - 800 pages, 2nd edition (March 1, 2000), Degnon Associates Inc.; ISBN: 0965683729; http://www.amazon.com/exec/obidos/ASIN/0965683729/icongroupinterna
Vocabulary Builder Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Idiosyncrasy: An abnormal susceptibility to some drug, protein, or other agent which is peculiar to the individual. [EU] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH]
115
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with lactose intolerance and related conditions.
Researching Your Medications 117
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with lactose intolerance. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internetbased databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for lactose intolerance. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of lactose intolerance. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
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Your Medications: The Basics34 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of lactose intolerance. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with lactose intolerance take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for lactose intolerance. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
34
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 119
·
If you can get a refill, and how often.
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for lactose intolerance). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
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Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for lactose intolerance. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.35 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of lactose intolerance. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to lactose intolerance:
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
35
Researching Your Medications 121
Racemethionine ·
Systemic - U.S. Brands: M-Caps; Pedameth; Uracid http://www.nlm.nih.gov/medlineplus/druginfo/racemethionines ystemic202727.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html.
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm. Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information
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in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with lactose intolerance--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat lactose intolerance or potentially create deleterious side effects in patients with lactose intolerance. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
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A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with lactose intolerance. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with lactose intolerance. The FDA warns patients to watch out for36: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Development: Molecular Targets for Gi Diseases by Timothy S. Gaginella (Editor), Antonio Guglietta (Editor); Hardcover - 288 pages (December 1999), Humana Press; ISBN: 0896035891; http://www.amazon.com/exec/obidos/ASIN/0896035891/icongroupinterna · Drug Therapy for Gastrointestinal and Liver Diseases by Michael J.G. Farthing, M.D. (Editor), Anne B. Ballinger (Editor); Hardcover - 346 pages, 1st edition (August 15, 2001), Martin Dunitz Ltd.; ISBN: 1853177334; http://www.amazon.com/exec/obidos/ASIN/1853177334/icongroupinterna
36
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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· Immunopharmacology of the Gastrointestinal System (Handbook of Immunopharmacology) by John L. Wallace (Editor); Hardcover (October 1997), Academic Press; ISBN: 0127328602; http://www.amazon.com/exec/obidos/ASIN/0127328602/icongroupinterna · A Pharmacologic Approach to Gastrointestinal Disorders by James H. Lewis, M.D. (Editor); Hardcover – (February 1994), Lippincott, Williams & Wilkins; ISBN: 0683049704; http://www.amazon.com/exec/obidos/ASIN/0683049704/icongroupinterna
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to lactose intolerance. Finally, at the conclusion of this chapter, we will provide a list of readings on lactose intolerance from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?37 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 37
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?38 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
38
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.39
39
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Lactose Intolerance Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for lactose intolerance. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to lactose intolerance and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “lactose intolerance” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to lactose intolerance: ·
A genetic study of lactose digestion in Nigerian families. Author(s): Ransome-Kuti O, Kretchmer N, Johnson JD, Gribble JT.
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Source: Gastroenterology. 1975 March; 68(3): 431-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1112447&dopt=Abstract ·
A soy protein formula and a milk-based formula. A comparative evaluation in milk-tolerant infants showed no significant nutritional differences. Author(s): Jung AL, Carr SL. Source: Clinical Pediatrics. 1977 November; 16(11): 982-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=578789&dopt=Abstract
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Allergy to cow's milk in the first year of life and its prevention. Author(s): Wilson NW, Hamburger RN. Source: Ann Allergy. 1988 November; 61(5): 323-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3056124&dopt=Abstract
·
Colchicine-induced lactose malabsorption in patients with familial Mediterranean fever. Author(s): Fradkin A, Yahav J, Zemer D, Jonas A. Source: Isr J Med Sci. 1995 October; 31(10): 616-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7591685&dopt=Abstract
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Congenital lactase deficiency. A clinical study on 16 patients. Author(s): Savilahti E, Launiala K, Kuitunen P. Source: Archives of Disease in Childhood. 1983 April; 58(4): 246-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6847226&dopt=Abstract
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Cow versus soy formulas. Comparative evaluation in normal infants. Author(s): Cherry FF, Cooper MD, Stewart RA, Platou RV. Source: Am J Dis Child. 1968 June; 115(6): 677-92. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5694767&dopt=Abstract
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Diet in gastrointestinal diseases. Author(s): Manier JW.
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Source: The Medical Clinics of North America. 1970 November; 54(6): 1357-65. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4321135&dopt=Abstract ·
Dietary management of lactose intolerance--lactase treated milk versus soya milk. Author(s): Gupta R, Gupta S. Source: Indian J Med Sci. 1993 January; 47(1): 1-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8514340&dopt=Abstract
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Dietary treatment of lactose intolerance in infants and children. Author(s): Sinden AA, Sutphen JL. Source: J Am Diet Assoc. 1991 December; 91(12): 1567-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1960350&dopt=Abstract
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Editorial: Evolution, lactase levels, and global hunger. Author(s): Almy TP. Source: The New England Journal of Medicine. 1975 May 29; 292(22): 1183-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1173193&dopt=Abstract
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Effect of a bulk-forming cathartic on diarrhea in tube-fed patients. Author(s): Heather DJ, Howell L, Montana M, Howell M, Hill R. Source: Heart & Lung : the Journal of Critical Care. 1991 July; 20(4): 40913. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1906447&dopt=Abstract
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Effect of a vegetable-protein-rich polymeric diet treatment on body composition and energy metabolism in inactive Crohn's disease. Author(s): Capristo E, Mingrone G, Addolorato G, Greco AV, Gasbarrini G. Source: European Journal of Gastroenterology & Hepatology. 2000 January; 12(1): 5-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10656203&dopt=Abstract
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·
Effect of fiber on breath hydrogen response and symptoms after oral lactose in lactose malabsorbers. Author(s): Nguyen KN, Welsh JD, Manion CV, Ficken VJ. Source: The American Journal of Clinical Nutrition. 1982 June; 35(6): 1347-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6282106&dopt=Abstract
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Efficacy of traditional rice-lentil-yogurt diet, lactose free milk proteinbased formula and soy protein formula in management of secondary lactose intolerance with acute childhood diarrhoea. Author(s): Nizami SQ, Bhutta ZA, Molla AM. Source: Journal of Tropical Pediatrics. 1996 June; 42(3): 133-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8699577&dopt=Abstract
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Environmental influences on lactose tolerance. Author(s): Johnson RC, Ayau EP, Ching CA, Nagoshi CT, Yuen S, Huang YH, Fjelstad K. Source: Behavior Genetics. 1987 July; 17(4): 313-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3675524&dopt=Abstract
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Evolutionary and social aspects of disease. Author(s): Russell WM, Russell C. Source: Ecol Dis. 1983; 2(2): 95-106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6689592&dopt=Abstract
·
Gastroesophageal reflux in children with recurrent abdominal pain. Author(s): van der Meer SB, Forget PP, Kuijten RH, Arends JW. Source: Acta Paediatrica (Oslo, Norway : 1992). 1992 February; 81(2): 13740. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1515756&dopt=Abstract
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History and current status of infant formulas. Author(s): Anderson SA, Chinn HI, Fisher KD.
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Source: The American Journal of Clinical Nutrition. 1982 February; 35(2): 381-97. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7039294&dopt=Abstract ·
Lactase deficiency in Australian school children. Author(s): Brand JC, Darnton-Hill I. Source: Med J Aust. 1986 October 6; 145(7): 318-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3762458&dopt=Abstract
·
Lactase deficiency in the South African black population. Author(s): Segal I, Gagjee PP, Essop AR, Noormohamed AM. Source: The American Journal of Clinical Nutrition. 1983 December; 38(6): 901-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6650448&dopt=Abstract
·
Lactose digestion and tolerance in adult and elderly Asian-Americans. Author(s): Suarez FL, Savaiano DA. Source: The American Journal of Clinical Nutrition. 1994 May; 59(5): 1021-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8172085&dopt=Abstract
·
Lactose intolerance in persistent diarrhoea during childhood: the role of a traditional rice-lentil (Khitchri) and yogurt diet in nutritional management. Author(s): Bhutta ZA, Nizami SQ, Isani Z. Source: J Pak Med Assoc. 1997 January; 47(1): 20-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9056732&dopt=Abstract
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Lactose maldigestion, calcium intake and osteoporosis in African-, Asian-, and Hispanic-Americans. Author(s): Jackson KA, Savaiano DA. Source: J Am Coll Nutr. 2001 April; 20(2 Suppl): 198S-207S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11349943&dopt=Abstract
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Medical aspects of Aboriginal health. Author(s): Moodie PM.
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Source: Aust Fam Physician. 1977 October; 6(10): 1309-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=588146&dopt=Abstract ·
Nursing caries and lactose intolerance. Author(s): Juambeltz JC, Kula K, Perman J. Source: Asdc J Dent Child. 1993 November-December; 60(4): 377-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8126301&dopt=Abstract
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Nutritional management of common gastrointestinal problems. Author(s): Spollett GR. Source: Nurse Pract Forum. 1994 March; 5(1): 24-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8148654&dopt=Abstract
·
Nutritional supplements used in weight-reduction programs increase intestinal gas in persons who malabsorb lactose. Author(s): Suarez FL, Zumarraga LM, Furne JK, Levitt MD. Source: J Am Diet Assoc. 2001 December; 101(12): 1447-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11762740&dopt=Abstract
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Overcoming the barrier of lactose intolerance to reduce health disparities. Author(s): Jarvis JK, Miller GD. Source: J Natl Med Assoc. 2002 February; 94(2): 55-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11853047&dopt=Abstract
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Predictors of milk consumption in a population of 17- to 35-year-old military personnel. Author(s): Klesges RC, Harmon-Clayton K, Ward KD, Kaufman EM, Haddock CK, Talcott GW, Lando HA. Source: J Am Diet Assoc. 1999 July; 99(7): 821-6; Quiz 827-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10405680&dopt=Abstract
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Primary adult lactose intolerance and the milking habit: a problem in biologic and cultural interrelations. II. A culture historical hypothesis. Author(s): Simoons FJ.
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Source: Am J Dig Dis. 1970 August; 15(8): 695-710. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5468838&dopt=Abstract ·
Primary adult lactose intolerance and the milking habit: a problem in biological and cultural interrelations. I. Review of the medical research. Author(s): Simoons FJ. Source: Am J Dig Dis. 1969 December; 14(12): 819-36. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4902756&dopt=Abstract
·
Prophylactic and therapeutic uses of probiotics: a review. Author(s): Kopp-Hoolihan L. Source: J Am Diet Assoc. 2001 February; 101(2): 229-38; Quiz 239-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11271697&dopt=Abstract
·
Recurrent abdominal pain and lactose absorption in children. Author(s): Lebenthal E, Rossi TM, Nord KS, Branski D. Source: Pediatrics. 1981 June; 67(6): 828-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7195004&dopt=Abstract
·
Soy protein intolerance: four patients with concomitant cow's milk intolerance. Author(s): Whitington PF, Gibson R. Source: Pediatrics. 1977 May; 59(5): 730-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=558576&dopt=Abstract
·
The response to dietary treatment of patients with chronic postinfectious diarrhea and lactose intolerance. Author(s): Lifshitz F, Fagundes-Neto U, Ferreira VC, Cordano A, Ribeiro Hda C. Source: J Am Coll Nutr. 1990 June; 9(3): 231-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2358619&dopt=Abstract
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Wheat extract and milk mixture as a milk substitute for children with milk intolerance.
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Author(s): Suthutvoravut U, Tontisirin K, Varavithya W, Valyasevi A, Bjorck I, Dahlqvist A. Source: J Diarrhoeal Dis Res. 1984 September; 2(3): 168-72. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6512217&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to lactose intolerance; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation:
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·
General Overview Lactose Intolerance Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm Lactose intolerance Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/lac toseintolerance.html
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Herbs and Supplements Acidophilus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm Acidophilus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Blackberry Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Bladderwrack Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Blueberry Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm
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Bovine Colostrum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Brewer's Yeast Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Carob Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Chamomile Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Chymotrypsin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Colostrum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Cranesbill Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Digestive enzymes Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 51,00.html Fiber Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Goldenseal Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Herbal Medicine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm L. Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Lacto bacillusacidophiluscs.html Lactase Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm Lactase Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Lactase.htm Lactase Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Lactobacillus Acidophilus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm Lactobacillus Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Lacto bacillusacidophiluscs.html Lactulose Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm Marshmallow Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Metoclopramide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Metoclopramide.htm Oak Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Probiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Psyllium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Raspberry Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Trypsin Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm ·
Related Conditions Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Allergies.htm Diarrhea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Indigestion, Heartburn, and Low Stomach Acidity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Indigestion.htm Malabsorption Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Malabsorption.htm Migraine Headaches Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Migraine.htm
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by
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title; hyperlinks Amazon.com):
provide
rankings,
information,
and
reviews
at
· Gastrointestinal Disorders and Nutrition by Tonia Reinhard; Paperback 192 pages (January 24, 2002), McGraw-Hill Professional Publishing; ISBN: 0737303611; http://www.amazon.com/exec/obidos/ASIN/0737303611/icongroupinterna · Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; Paperback - 256 pages, 1st edition (February 2000), John Wiley & Sons; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna · No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, M.D.; Paperback - 320 pages (February 2000), Kensington Publishing Corp.; ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with lactose intolerance. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with lactose intolerance may be given different recommendations. Some recommendations may be directly related to lactose intolerance, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of lactose intolerance. We will then show you how to find studies dedicated specifically to nutrition and lactose intolerance.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:40 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
40
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?41
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”42 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.43 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 42 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 43 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 41
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the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Lactose Intolerance The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.44 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
44
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periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “lactose intolerance” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on lactose intolerance: ·
Lessons in comparative physiology: lactose intolerance. Source: Filer, L.J. Jr. Reynolds, W.A. Nutrition-today (USA). (Mar-April 1997). volume 32(2) page 79-81. digestive disorders biological differences milk proximate composition aquatic animals wild animals human nutrition 0029-666X Summary: trouble digestif difference biologique lait composition globale animal aquatique animal sauvage nutrition humaine
Additional consumer oriented references include: ·
Can't stomach milk? Keep lactose intolerance at bay. Source: Lepke, J. Environ-nutr. New York : Environmental Nutrition, Inc.,. October 1993. volume 16 (10) page 2. 0893-4452
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Lactose intolerance and irritable bowel syndrome. Author(s): Division of Digestive Disease and Nutrition, University of Massachusetts Memorial Health Care, Worcester 01655, USA. Source: Mascolo, R Saltzman, J R Nutr-Revolume 1998 October; 56(10): 306-8 0029-6643
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Marketers milk misconceptions on lactose intolerance. Source: Tufts-Univ-diet-nutr-lett. New York, N.Y. : Tufts University Diet and Nutrition Letter, 1983-c1997. December 1994. volume 12 (10) page 47. 0747-4105
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Most frequently asked questions about lactose intolerance. Author(s): Cornell University Medical College. Source: Levine, B. Nutrition-today (USA). (April 1996). volume 31(2) page 78-79. digestive disorders symptoms foods children nutrients supplements 0029-666X
The following information is typical of that found when using the “Full IBIDS Database” when searching using “lactose intolerance” (or a synonym):
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·
Breath testing in intestinal disaccharidase deficiency and bacterial overgrowth of the small intestine. Source: Lee, M.J. Barrie, S. Levinson, U. J-nutr-environ-med. Abingdon, U.K. : Carfax Publishing Company. March 1996. volume 6 (1) page 43-54. 1359-0847
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Calcium absorption and acceptance of low-lactose milk among children with primary lactase deficiency. Source: Nielsen, Ole Haagen. Schiotz, P.O. Rasmussen, S.N. Krasilnikoff, P.A. J-Pediatr-Gastroenterol-Nutr. New York : Raven Press. 1984. volume 3 (2) page 219-223. charts. 0277-2116
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Chemotherapy-induced lactose intolerance in adults. Author(s): University of Maryland Cancer Center, Division of Hematology/Medical Oncology, Baltimore 21201. Source: Parnes, H L Fung, E Schiffer, C A Cancer. 1994 September 1; 74(5): 1629-33 0008-543X
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Diet, genetics, and lactose intolerance. Source: Suarez, F.L. Savaiano, D.A. Food-technol. Chicago : Institute of Food Technologists 1947-. March 1997. volume 51 (3) page 74-76. 00156639
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Efficacy of exogenous lactase for lactose intolerance. Source: Nutrition-reviews (USA). (April 1988). volume 46(4) page 150152. digestive disorders galactosidases metabolic disorders prevention children 0029-6643
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Lactose intolerance. Source: Castiglia, P T J-Pediatr-Health-Care. 1994 Jan-February; 8(1): 36-8 0891-5245
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Overcoming the barrier of lactose intolerance to reduce health disparities. Author(s): National Dairy Council, Rosemont, Illinois 60018-5616 USA. Source: Jarvis, Judith K Miller, Gregory D J-Natl-Med-Assoc. 2002 February; 94(2): 55-66 0027-9684
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Practical significance of lactose intolerance in children: supplement. Source: Pediatrics. Elk Grove Village, Ill. : American Academy of Pediatrics. October 1990. volume 86 (4) page 643-644. 0031-4005
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Properties of porcine and yogurt lactobacilli in relation of to lactose intolerance. Source: Burton, J.P. Tannock, G.W. J-dairy-sci. Savoy, Ill. : American Dairy Science Association. October 1997. volume 80 (10) page 2318-2324. 0022-0302
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·
The prevalence of lactase deficiency and lactose intolerance in Chinese children of different ages. Author(s): Institute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine, Beijing 100050, China. Source: Yang, Y He, M Cui, H Bian, L Wang, Z Chin-Med-J-(Engl). 2000 December; 113(12): 1129-32 0366-6999
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to lactose intolerance; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Ascorbic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm
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Minerals Calcium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm Calcium Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Calcium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Calcium.htm Folate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Potassium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm ·
Food and Diet Apples Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Applesauce Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Bananas Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Berries Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm
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Cheese Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Cream Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Dairy-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Dairy_Free_Diet.htm Fruit Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Ice Cream Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm
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Milk Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,95,00.ht ml Rice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Soup Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Sugar Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm Tea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Wheat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Yogurt Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Lactose_Intolerance.h tm
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Yogurt Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diarrhea.htm Yogurt Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,97,00.ht ml
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Galactosidases: A family of galactoside hydrolases that hydrolyze compounds with an O-galactosyl linkage. EC 3.2.1.-. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It
Researching Nutrition 159
occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 161
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.45
45
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):46 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
46
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 163
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 165
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 167
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
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APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with lactose intolerance faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.47 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
47Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
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Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
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Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
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plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
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Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
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Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
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Discuss all current treatments a consumer may be undergoing.
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Discuss all risks, nontreatment.
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Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
172 Lactose Intolerance
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
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healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.48
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”49 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 49 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 48
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
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Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
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Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
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Make a good-faith effort to meet financial obligations.
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Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.50 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.51 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 51 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 50
Online Glossaries 175
3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
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contact information on how to find more in-depth information about Medicaid.52
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
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phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.53 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:54 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to lactose intolerance and keep them on file. The NIH, in particular, suggests that patients with lactose intolerance visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Lactose Intolerance AIDS Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000594.htm Lactose intolerance Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000276.htm
·
Signs & Symptoms for Lactose Intolerance Abdominal bloating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003123.htm Abdominal cramping Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Abdominal cramps Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Abdominal distention Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003122.htm Abdominal fullness, gaseous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003124.htm Bloating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003123.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm
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Flatulence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003124.htm Growth, slow (child 0-5 years) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003021.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Stools - floating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003128.htm Stools - foul smelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003132.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm ·
Diagnostics and Tests for Lactose Intolerance ALT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Differential Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm
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Lactose tolerance test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003500.htm PRA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003698.htm Small bowel biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003889.htm ·
Nutrition for Lactose Intolerance Protein Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm Riboflavin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002411.htm Vitamin D Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002405.htm Yogurt Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002463.htm
·
Background Topics for Lactose Intolerance Enzyme Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002353.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm
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Relieved by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002288.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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LACTOSE INTOLERANCE GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Acidity: L. aciditas) the quality of being acid or sour; containing acid (hydrogen ions). [EU] Aerobic: 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. [EU] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH]
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Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carmine: Coloring matter from the insect Coccus cacti L. It is used in foods, pharmaceuticals, toiletries, etc., as a dye, and also has use as a microscopic stain and biological marker. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholecystitis: Inflammation of the gallbladder. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [EU] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU]
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Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dermatitis: Inflammation of the skin. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Dietetics: The study and regulation of the diet. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Distention: The state of being distended or enlarged; the act of distending. [EU]
Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced
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efficiency to respond to stimuli. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Galactosidases: A family of galactoside hydrolases that hydrolyze compounds with an O-galactosyl linkage. EC 3.2.1.-. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH]
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Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatitis: Inflammation of the liver. [EU] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Hunger: The desire for food generated by a sensation arising from the lack of food in the stomach. [NIH] Hydrogen: Hydrogen. The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Idiosyncrasy: An abnormal susceptibility to some drug, protein, or other agent which is peculiar to the individual. [EU] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH]
Ileus: Obstruction of the intestines. [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Infertility:
The diminished or absent ability to conceive or produce an
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offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Inguinal: Pertaining to the inguen, or groin. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Megacolon: An abnormally large or dilated colon; the condition may be congenital or acquired, acute or chronic. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to
Glossary 193
the chin. [EU] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH]
Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Orthostatic: Pertaining to or caused by standing erect. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Pathogen: Any disease-producing microorganism. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to
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pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Pernicious: Tending to a fatal issue. [EU] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Proctitis: Inflammation of the rectum. [EU] Propantheline: A muscarinic antagonist used as an antispasmodic, in rhinitis, in urinary incontinence, and in the treatment of ulcers. At high doses it has nicotinic effects resulting in neuromuscular blocking. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Puberty: The period during which the secondary sex characteristics begin to
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develop and the capability of sexual reproduction is attained. [EU] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Reflux: A backward or return flow. [EU] Refractory: Not readily yielding to treatment. [EU] Rehydration: The restoration of water or of fluid content to a body or to substance which has become dehydrated. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Sedative: 1. allaying activity and excitement. 2. an agent that allays excitement. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a
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particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
Glossary 197
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
198 Lactose Intolerance
INDEX A Abdominal...20, 26, 44, 46, 48, 49, 63, 72, 74, 78, 80, 104, 133, 136, 188, 190, 194 Acidity ..................................12, 13, 22, 23 Adverse .........................................94, 105 Aerobic ..................................................85 Alimentary......................................27, 192 Anaphylaxis ...................................84, 105 Anemia ....................................75, 76, 110 Anomalies ..............................................44 Anorexia ............................26, 63, 73, 190 Antigen ....................................44, 85, 187 Antimicrobial ..........................................47 Antispasmodic .........................21, 55, 194 Appendicitis .................62, 64, 76, 78, 189 B Bacteria ......12, 13, 27, 53, 54, 84, 85, 86, 146, 187, 190, 193, 195 Benign .............................................45, 63 Biliary.....................................76, 113, 191 Biopsy................................44, 49, 82, 184 C Capsules............................42, 58, 85, 149 Carbohydrate...................27, 85, 148, 190 Carmine .................................................42 Chemotherapy .......................................22 Cholangitis.............................................64 Cholecystitis ....................................64, 83 Cholesterol ..............55, 63, 146, 148, 195 Chronic .21, 30, 46, 49, 51, 53, 72, 73, 78, 79, 95, 102, 103, 136, 170, 188, 192 Cirrhosis ................................................64 Colitis ...........30, 62, 63, 64, 72, 73, 74, 76 Colorectal ........................................63, 76 Concomitant ........................................136 Constipation 21, 62, 63, 64, 74, 76, 77, 80, 94, 95, 102, 103, 104, 194 Contracture............................................69 Cyclic .....................................................62 D Dehydration .........................13, 47, 75, 76 Diarrhoea.......................26, 133, 134, 190 Dietetics ...........................................45, 75 Digestion.....12, 15, 28, 43, 47, 53, 55, 69, 78, 89, 103, 105, 130, 134, 187, 189, 194, 195 Distention...................44, 49, 54, 182, 190 Diverticulitis ...............................62, 63, 76 Dyspepsia........................................62, 94 Dysphagia..............................................76
E Electrolyte ................................... 158, 194 Enzyme .... 11, 12, 14, 15, 20, 26, 43, 48, 50, 54, 59, 82, 88, 96, 104, 189, 190 Epidemic ............................................... 96 Exogenous .......................... 152, 158, 189 F Fatigue .......................................... 74, 103 Fats ................... 78, 83, 86, 146, 188, 190 Feces .................................................... 44 Fermentation......................................... 50 Fissure ............................................ 63, 64 Flatulence ........................... 47, 49, 73, 82 G Galactosidases ................................... 152 Gastritis..................................... 63, 64, 76 Gastroenteritis .................... 24, 63, 76, 94 Gastrointestinal .... 21, 27, 42, 43, 45, 46, 59, 73, 74, 76, 89, 94, 95, 102, 103, 105, 131, 135, 190 Glucose..... 12, 13, 27, 42, 47, 50, 59, 70, 79, 80, 82, 190, 192, 193 Gluten ........................... 30, 44, 62, 65, 74 H Heartburn .......... 62, 63, 64, 74, 76, 94, 95 Hematology........................................... 10 Hemorrhoids ............................. 62, 64, 76 Hepatitis ................................................ 77 Hepatobiliary ....................................... 102 Hernia ............................................. 63, 64 Hunger ................................................ 132 Hypersensitivity............... 84, 85, 113, 187 Hypertension..................... 46, 70, 83, 102 I Idiosyncrasy ........................................ 105 Ileostomy............................................... 62 Ileus ...................................................... 76 Immunity ............................................... 69 Incontinence ..................... 55, 63, 77, 194 Infertility................................... 28, 44, 196 Inflammation ..... 26, 73, 74, 78, 188, 189, 190 Ingestion ............. 42, 45, 46, 80, 149, 194 Inguinal ................................................. 76 Insulin.......... 27, 70, 79, 80, 190, 192, 193 Intestines...... 12, 21, 26, 54, 59, 79, 190, 191 Iris ................................................. 79, 192 J Jaundice................................................ 77
Index 199
L Lupus .....................................................63 M Malabsorption ...4, 49, 69, 71, 76, 84, 110, 131 Malignant .................................45, 53, 188 Megacolon .............................................75 Menopause............................................24 Mental ....... 31, 63, 69, 78, 102, 125, 128, 172, 189 Metoclopramide .....................................42 Molecular .........10, 85, 100, 107, 109, 187 N Nausea .....11, 23, 26, 49, 73, 76, 95, 103, 104, 105, 190 Neural ............................................71, 147 Niacin...................................................147 O Operon.............................................84, 85 Oral ..47, 51, 54, 64, 73, 95, 133, 188, 193 Orthostatic .............................................68 Osteoporosis .14, 18, 46, 52, 88, 102, 134 Overdose .............................................147 Oxalates ................................................17 P Pancreas ...................76, 79, 80, 192, 193 Parasitic .................................................59 Pathologic........................................49, 73 Peptic.....................................................47 Peritonitis ...............................................76 Pernicious ..............................................76 Pharmacist...................................118, 122 Pharmacologic.........................28, 44, 196 Poisoning.................................27, 63, 190 Potassium............................................148 Predisposition ........................................50 Prednisone ............................................94
Prevalence ................ 46, 71, 72, 102, 153 Proctitis ................................................. 76 Propantheline........................................ 42 Proteins................... 53, 73, 146, 148, 187 Puberty.................................................. 51 R Reflex.................................................... 96 Reflux...................................... 62, 94, 133 Refractory ............................................. 49 Rehydration..................................... 47, 95 Remission ............................................. 73 Resection .............................................. 72 Riboflavin ............................................ 146 S Selenium ............................................. 148 Skeletal ................................................. 52 Sneezing ............................................. 105 Somatic ................................................. 43 Spectrum......................................... 10, 44 Sphincter................................. 75, 80, 195 Steroid............................................. 51, 73 Stomach..... 18, 20, 26, 27, 47, 54, 63, 75, 76, 78, 80, 82, 104, 151, 190, 191, 193 Symptomatic ..................... 46, 47, 55, 196 T Thermoregulation................................ 146 Thyroxine ............................................ 148 Toxicology............................... 10, 70, 101 U Ulceration.............................................. 74 Urinary ........ 28, 42, 55, 79, 191, 194, 196 Urology.................................................. 10 V Visceral ................................................. 44 W Withdrawal ............................................ 82
200 Lactose Intolerance
